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[Countermeasure for obstetric hemorrhage].

¹Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo 113-8603.

Masui. the Japanese Journal of Anesthesiology

|March 17, 2010

Summary

Obstetric hemorrhage remains a critical cause of maternal death in Japan, despite overall declines. Defining normal blood loss varies by delivery type, and prompt treatment of disseminated intravascular coagulation (DIC) with fresh frozen plasma (FFP) is crucial.

Area of Science:

Obstetrics and Gynecology
Critical Care Medicine
Hematology

Background:

Maternal mortality in Japan has decreased, yet obstetric hemorrhage persists as a significant cause of death, alongside embolism and hypertension.
The Japan Society of Obstetrics and Gynecology (JSOG) defines intrapartum abnormal bleeding as >500 ml hemorrhage.
Official Japanese peripartum data reveal upper normal hemorrhage limits vary significantly by delivery mode and fetal number (e.g., 900g vaginal singleton vs. 2600g multifetal cesarean).

Observation:

Obstetric Disseminated Intravascular Coagulation (DIC) is characterized by consumptive coagulopathy and enhanced fibrinolysis.
Treatment strategies for obstetric DIC prioritize compensating for depleted coagulation factors, with Fresh Frozen Plasma (FFP) being a primary intervention.
FFP requires thawing, a time-consuming process, highlighting the need for prompt decision-making and administration.

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Findings:

Antithrombin administration may be considered over platelet concentrates for managing obstetric DIC.
Guidelines for managing obstetric critical hemorrhage, developed by anesthesiologists and JSOG, recommend interventions based on the shock index.
Severe cases, such as placenta previa with accreta or placental abruption, necessitate a multidisciplinary, prompt approach.

Implications:

Effective management of obstetric hemorrhage and DIC relies on timely estimation and decisive action by healthcare professionals.
Advanced critical care devices can support severe cases, but clinical judgment remains paramount.
Standardized guidelines and rapid treatment protocols are essential for improving outcomes in obstetric critical hemorrhage.