[Countermeasure for obstetric hemorrhage]

Although the number of maternal death in Japan has decreased especially since 1990's and its total number has reached the level of developed countries, obstetric hemorrhage is still equally important as obstetric embolism and hypertension in pregnancy as a cause of maternal death. Intrapartum abnormal bleeding is defined as hemorrhage which amounts to more than 500 ml during intrapartum period by Japan Society of Obstetrics and Gynecology (JSOG). However, according to the official register of peripartum data in Japan, the upper normal limit (mean + 1.5 SD) of the amount of hemorrhage during intrapartum period was 900 g at vaginal singleton delivery, 1600 g at singleton cesarean delivery, 1900 g at multifetal vaginal delivery and 2600 g at multifetal cesarean delivery. Thus, upper normal limit is varied depending on mode of deliveries and fetal number. The character of obstetric DIC is marked consumptive coagulopathy and increased fibrinolytic system. Principal strategy for treatment of obstetric DIC is compensation of expended coagulating factors. Thus, the most important strategy is to administer FFP However, it is necessary to be unfreezed for administration of FFP, and it is time-consuming. Prompt and firm decision for administration of FFP is important. Priority of administration of platelet concentrate is not high. Rather the use of antithrombin should be considered. Guideline of response to obstetric critical hemorrhage has been tentatively constructed by Japanese Society of Anesthesiologists, JSOG and other related academic societies. According to the guideline, recommended medical intervention depends on the shock index. At the extremely severe clinical state like placenta previa with accreta and placental abruption, multidisciplinary and prompt approach fulfills very important role to bring through. Strategy of treatment for obstetric DIC and the guideline of response to obstetric critical hemorrhage are also important at such state. Level 1 and other medical devices for critical care also become strong tools for severe cases. However, the most important is adequate and prompt estimation and direction by workforce.