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Haemorrhage at caesarean section: a framework for prevention and research
Jennifer E Jardine1, Penny Law, Matthew Hogg
1aRoyal London Hospital, Barts Health NHS Trust bWomen's Health Research Unit, Barts and the London School of Medicine, Queen Mary University of London cHillingdon Hospital, London, UK dDepartment of Obstetrics and Gynaecology, Trinity College, University of Dublin, Ireland eUniversity College London, London, UK.
Current Opinion in Obstetrics & Gynecology
|November 3, 2016
Summary
Postpartum hemorrhage after cesarean delivery can be managed with medications like tranexamic acid and ergometrine. Antenatal anemia correction and intraoperative oxytocics are also key strategies.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Background:
- Caesarean section rates are rising globally.
- Postpartum haemorrhage (PPH) is a significant cause of maternal morbidity and mortality, with higher incidence after caesarean delivery.
- Current practices for PPH prevention and treatment during caesarean sections vary widely.
Purpose of the Study:
- To review and summarize current expert opinions on managing postpartum haemorrhage specifically in the context of caesarean sections.
Main Methods:
- Review of recent large and small randomized controlled trials.
- Analysis of current medical management strategies for intraoperative PPH.
- Consideration of ongoing trials for cell salvage and tranexamic acid.
Main Results:
- Recent trials suggest potential benefits from routine tranexamic acid and ergometrine use.
- Smaller trials indicate possible advantages of carbetocin.
- Antenatal anemia correction can mitigate PPH impact. Intraoperative management includes oxytocin, other oxytocics, and tranexamic acid, with optimal sequencing still under investigation.
Conclusions:
- Evidence supports the use of specific uterotonics and tranexamic acid in PPH management during caesarean delivery.
- Further research, including ongoing trials, is crucial to refine optimal management protocols.
- A multi-faceted approach, including antenatal and intraoperative interventions, is necessary to reduce PPH-related complications.
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