Use of recombinant activated factor VII in massive postpartum haemorrhage

Postpartum haemorrhage (PPH) remains an important cause of maternal morbidity and mortality. With regard to morbidity, preservation of the uterus is of paramount importance in fertile women. The objective of the study was to describe the cumulative experience of a cohort of women that were treated with recombinant factor VIIa.

In this retrospective, descriptive study we approached all departments of obstetrics and gynaecology in the Netherlands to find out if they had used rFVIIa for this indication. Twenty-seven cases were reported to us. To evaluate each case, we used a standardized case record form.

The main cause of PPH was uterine atony (82%). In 21 cases rFVIIa was explicitly given to prevent a hysterectomy. This was successful in 16 cases (76%). Relevant reduction or complete cessation of bleeding after rFVIIa was noted in 24/27 cases (89%). There was a reduction in blood product requirements following rFVIIa administration. The dose of rFVIIa was variable and ranged from 16 to 128mug/kg.

There appears to be a role for the use of rFVIIa in PPH unresponsive to conventional therapy. Recombinant FVIIa can be helpful and avoid an emergency hysterectomy.