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Related Experiment Videos

Acquired bleeding disorders: bleeding in obstetrics and surgery

J Bonnar1

  • 1Trinity College, Department of Obstetrics and Gynaecology, St James Hospital, Dublin, Ireland.

The Southeast Asian Journal of Tropical Medicine and Public Health
|January 1, 1993
PubMed
Summary

Severe obstetric hemorrhage remains a global maternal mortality cause. Addressing defective hemostasis and ensuring proper management protocols are crucial for preventing preventable deaths.

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Area of Science:

  • Obstetrics and Gynecology
  • Hematology
  • Public Health

Background:

  • Hemorrhage is the primary cause of maternal mortality and morbidity globally.
  • In England and Wales (1970-1987), hemorrhage contributed to over 40 maternal deaths, often with substandard care.
  • Defective hemostasis is a significant factor in 70% of obstetric hemorrhage deaths.

Purpose of the Study:

  • To highlight the critical role of hemostasis in obstetric hemorrhage.
  • To identify preventable causes of death related to hemorrhage management.
  • To emphasize the need for established protocols in managing severe obstetric bleeding.

Main Methods:

  • Review of maternal mortality data focusing on hemorrhage cases.
  • Analysis of contributing factors to death, including hemostatic defects and hypovolemia.

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  • Discussion of management strategies, including blood product transfusion and surgical intervention.

    • Main Results:

    • Substandard care was noted in the majority of maternal deaths due to hemorrhage.
    • Preventable deaths resulted from inadequate correction of hypovolemia, failure to manage coagulation defects, and uncontrolled traumatic bleeding.
    • In resource-limited settings, availability of cross-matched blood and products is a challenge.

    Conclusions:

    • Correction of hemostatic defects with fresh frozen plasma and platelet concentrates is vital before or during surgery.
    • Effective management of severe obstetric hemorrhage requires teamwork and established protocols involving medical, nursing, and laboratory staff.
    • Proactive management strategies are essential to reduce maternal mortality from hemorrhage.