[Inter-hospital transfer for severe postpartum hemorrhage].

Area of Science:

• Obstetrics and Gynecology
• Emergency Medicine
• Critical Care Medicine

Background:

• Severe postpartum hemorrhage (PPH) can necessitate specialized care beyond a single institution's capabilities.
• Inter-hospital transfer is a critical management strategy for complex PPH cases.

Purpose of the Study:

• To establish guidelines for the safe and effective inter-hospital transfer of patients experiencing severe postpartum hemorrhage.
• To define the conditions and multidisciplinary approach required for successful patient transfer.

Main Methods:

• A comprehensive bibliographic search was conducted using PubMed, accessing the Medline and Cochrane databases.
• Key literature was reviewed to synthesize evidence regarding PPH management and inter-hospital transfers.

Main Results:

• Inter-hospital transfer for severe PPH is indicated for interventions like arterial embolization or intensive care unit (ICU) admission.
• Transfer decisions require multidisciplinary input from obstetrics, anesthesiology-intensivists, and prehospital teams.
• Transfer may be contraindicated in cases of uncontrolled hemorrhagic shock, where local surgical hemostasis is preferred.
• Pre-transfer stabilization is crucial, including organ failure management and initiation of blood transfusion.
• Patients should be transferred to centers with comprehensive multidisciplinary support, including surgery, anesthesiology, ICU, interventional radiology, and blood bank services.

Conclusions:

• Inter-hospital transfer for severe PPH is feasible but contingent upon specific clinical conditions.
• Continuation of blood transfusion and correction of organ failure are essential prerequisites for safe transfer.
• Multidisciplinary collaboration and careful patient selection are paramount for successful outcomes in severe PPH transfers.