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DOI: 10.1055/a-2073-9615
Peripartum Haemorrhage, Diagnosis and Therapy. Guideline of the DGGG, OEGGG and SGGG (S2k, AWMF Registry No. 015-063, August 2022)
Article in several languages: English | deutsch- Abstract
- I Guideline Information
- II Guideline Application
- III Methodology
- IV Guideline
- References/Literatur
Abstract
Aim This official guideline was coordinated and published by the German Society of Gynaecology and Obstetrics (DGGG). The guideline aims to provide a consensus-based overview of the diagnosis and management of peripartum bleeding based on an evaluation of the relevant literature.
Methods This S2k-guideline was developed by representative members from different medical professions on behalf of the guidelines commission of the DGGG, OEGGG and SGGG using a structured consensus process.
Recommendations Recommendations for the definition, risk stratification, prevention, treatment (general emergency procedures, medications, uterine tamponade, surgical measures, interventional-radiological procedures, haemostasis, and coagulation management), transportation, documentation and debriefing as well as training are presented. In addition, a PPH algorithm for action, “PPH 2022”, is recommended.
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Key words
postpartum haemorrhage - postpartum bleeding - placenta accreta spectrum - PPH algorithm - uterotonic drugs - tranexamic acid - tamponade - surgical procedures - compression sutures - embolization - haemostasis and coagulation management - anaesthetic management - autotransfusionI Guideline Information
Guidelines programme of the DGGG, OEGGG and SGGG
For information on the guidelines programme, please refer to the end of the guideline.
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Citation format
Peripartum Haemorrhage, Diagnosis and Therapy. Guideline of the DGGG, OEGGG and SGGG (S2k, AWMF Registry No. 015-063, August 2022). Geburtsh Frauenheilk 2023. doi:10.1055/a-2073- 9615
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Guideline documents
The complete long version of this guideline in German together with a list of the conflicts of interest of all of the authors is available on the homepage of the AWMF: http://www.awmf.org/leitlinien/detail/ll/015-063.html
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Guideline authors
Author |
Professional society |
---|---|
PD Dr. med. Dietmar Schlembach |
German Society for Gynaecology and Obstetrics [Dt. Gesellschaft für Gynäkologie und Geburtshilfe e. V.] (DGGG) German Society for Prenatal and Obstetric Medicine [Dt. Gesellschaft für Pränatal- und Geburtsmedizin e. V.] (DGPGM) |
Author |
DGGG working group (AG)/ |
---|---|
Prof. Dr. med. Thorsten Annecke |
German Society of Anaesthesiology and Intensive Care Medicine [Dt. Gesellschaft für Anästhesiologie und Intensivmedizin e. V.] (DGAI) German Interdisciplinary Association of Intensive Care and Emergency Medicine [Dt. Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin e. V.] (DIVI) |
Prof. Dr. Thierry Girard |
Swiss Society for Anaesthesiology and Perioperative Medicine [Schweizerische Gesellschaft für Anästhesie und Perioperative Medizin] (SSAPM) |
Univ. Prof. Dr. med. univ. Hanns Helmer |
Austrian Society for Gynaecology and Obstetrics [Österreichische Gesellschaft für Gynäkologie und Geburtshilfe] (OEGGG) |
Prof. Dr. med. Christian von Heymann |
German Society of Anaesthesiology and Intensive Care Medicine (DGAI) |
Prof. Dr. med. Franz Kainer |
German Society for Perinatal Medicine [Dt. Gesellschaft für Perinatale Medizin e. V.] (DGPM) German Interdisciplinary Association of Intensive Care and Emergency Medicine (DIVI) |
Prof. Dr. med. Sven Kehl |
German Society of Ultrasound in Medicine [Dt. Gesellschaft für Ultraschall in der Medizin e. V.] (DEGUM) |
Prof. Dr. med. Wolfgang Korte |
Society for Thrombosis and Haemostasis Research [Gesellschaft für Thrombose- und Hämostaseforschung e. V.] (GTH) |
Prof. Dr. med. Maritta Kühnert |
Working Group for Obstetrics and Prenatal Medicine [Arbeitsgemeinschaft für Geburtshilfe und Pränatalmedizin e. V.] (AGG) in the German Society for Gynaecology and Obstetrics (DGGG) |
Dr. med. Heiko Lier |
German Society of Anaesthesiology and Intensive Care Medicine (DGAI) |
Silke Mader |
European Foundation for the Care of Newborn Infants (EFCNI) |
Prof. Dr. med. Andreas Mahnken |
German Society for Interventional Radiology and Minimally Invasive Therapy [Dt. Gesellschaft für Interventionelle Radiologie und minimal invasive Therapie e. V.] (DeGIR) |
Hon.-Prof. Dr. med. habil. Holger Maul |
Professional Association of Gynaecologists [Berufsverband der Frauenärzte e. V.] (BVF) Working Group for Obstetrics and Prenatal Medicine (AGG) in the German Society for Gynaecology and Obstetrics (DGGG) |
Dr. med. univ. Georg Pfanner |
Austrian Society for Anaesthesiology, Reanimation and Intensive Medicine [Österreichische Gesellschaft für Anästhesiologie, Reanimation und Intensivmedizin] (ÖGARI) |
Andrea Ramsell |
German Midwives Association [Dt. Hebammenverband e. V.] (DHV) |
PD Dr. med. Dietmar Schlembach |
Working Group for Obstetrics and Prenatal Medicine (AGG) in the German Society for Gynaecology and Obstetrics (DGGG) German Society for Prenatal and Obstetric Medicine (DGPGM) |
Prof. Dr. med. Daniel Surbek |
Swiss Society for Gynaecology and Obstetrics [Schweizer Gesellschaft für Gynäkologie und Geburtshilfe] (SGGG) |
Dr. med. Oliver Tiebel |
German Society for Clinical Chemistry and Laboratory Medicine [Dt. Gesellschaft für Klinische Chemie und Laboratoriumsmedizin e. V.] (DGKL) |
Laura Zinßer |
German Midwifery Society [Dt. Gesellschaft für Hebammenwissenschaft e. V.] (DGHWI) |
The following professional societies/working groups/organisations/associations stated that they wished to contribute to the guideline text and participate in the consensus conference and nominated representatives to attend the conference:
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II Guideline Application
Purpose and objectives
-
Presentation of an interdisciplinary algorithm for action and for the management of peripartum haemorrhage (diagnosis, risk selection, treatment)
-
To create the algorithm, the existing S2k-guideline had to be revised and updated.
-
The aim of revising the guideline was to update the knowledge of all persons caring for pregnant women and women in the postpartum period suffering from or with a higher risk of haemorrhage.
-
This should lead to a better care of these patients and reduce problems when managing PPH.
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Targeted areas of care
-
Outpatient and in-patient care
-
Prevention
-
Screening, diagnosis, management and therapy
-
Medical/specialist care
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Targeted patient groups
This guideline is aimed at pregnant women/women giving birth/women in the postpartum period.
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Target user groups/target audience
This guideline is aimed at the following groups of people:
-
gynaecologists (diagnostic examinations, outpatient care, treatment, prevention, screening)
-
anaesthetists, specialists for internal medicine, haemostasis specialists, clinical pathologists
-
midwives
and provides information for nursing staff (in the operating room and the postnatal ward).
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Adoption and period of validity
The validity of this guideline was confirmed by the executive boards/representatives of the participating medical professional societies, working groups, organizations, and associations and the board of the DGGG and the DGGG Guidelines Commission as well as by the boards of the SGGG and OEGGG in July 2022 and was thereby approved in its entirety. This guideline is valid from 1 August 2022 through to 31 July 2027. Because of the contents of this guideline, this period of validity is only an estimate.
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III Methodology
Basic principles
The method used to prepare this guideline was determined by the class to which this guideline was assigned. The AWMF Guidance Manual (version 2.0) has set out the respective rules and requirements for different classes of guidelines. Guidelines are differentiated into lowest (S1), intermediate (S2), and highest (S3) class. The lowest class is defined as consisting of a set of recommendations for action compiled by a non-representative group of experts. In 2004, the S2 class was divided into two subclasses: a systematic evidence-based subclass (S2e) and a structural consensus-based subclass (S2k). The highest S3 class combines both approaches.
This guideline was classified as: S2k.
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Grading of recommendations
The grading of evidence based on the systematic search, selection, evaluation, and synthesis of an evidence base which is then used to grade the recommendations is not envisaged for S2k guidelines. The individual statements and recommendations are only differentiated by syntax, not by symbols ([Table 3]).
Description of binding character |
Expression |
---|---|
Strong recommendation, highly binding |
must/must not |
Regular recommendation, moderately binding |
should/should not |
Open recommendation, not binding |
may/may not |
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Statements
Expositions or explanations of specific facts, circumstances, or problems without any direct recommendations for action included in this guideline are referred to as “statements.” It is not possible to provide any information about the level of evidence for these statements.
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Achieving consensus and level of consensus
At structured NIH-type consensus-based conferences (S2k/S3 level), authorised participants attending the session vote on draft statements and recommendations. The process is as follows. A recommendation is presented, its contents are discussed, proposed changes are put forward, and all proposed changes are voted on. If a consensus (> 75% of votes) is not achieved, there is another round of discussions, followed by a repeat vote. Finally, the extent of consensus is determined, based on the number of participants ([Table 4]).
Symbol |
Level of consensus |
Extent of agreement in percent |
---|---|---|
+++ |
Strong consensus |
> 95% of participants agree |
++ |
Consensus |
> 75 – 95% of participants agree |
+ |
Majority agreement |
> 50 – 75% of participants agree |
– |
No consensus |
< 51% of participants agree |
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Expert consensus
As the term already indicates, this refers to consensus decisions taken relating specifically to recommendations/statements issued without a prior systematic search of the literature (S2k) or where evidence is lacking (S2e/S3). The term “expert consensus” (EC) used here is synonymous with terms used in other guidelines such as “good clinical practice” (GCP) or “clinical consensus point” (CCP). The strength of the recommendation is graded as previously described in the chapter Grading of recommendations but without the use of symbols; it is only expressed semantically (“must”/“must not” or “should”/“should not” or “may”/“may not”).
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IV Guideline
1 Background
The reported incidence of postpartum haemorrhage (PPH) is 1 – 3% of all deliveries. Prospective studies have reported that quantitative measurement of blood loss resulted in a PPH rate of around 10% [1], [2], [3], [4]. The incidence of postpartum haemorrhage (PPH) is constantly increasing, mainly due to the rise in cases with uterine atony and placental implantation disorders as well as rising rates of operative vaginal and caesarean section deliveries leading to higher primary blood loss and, in cases delivered by caesarean section, higher PPH rates in subsequent pregnancies [5], [6], [7], [8], [9], [10], [11].
Life-threatening PPH affects around ca. 2/1000 deliveries in the West, with a reported rate of severe maternal morbidity of around 3/1000 deliveries [12], [13], [14], [15], [16], [17]. This makes PPH the cause of around 30% of all maternal deaths in low and middle-income countries and 13% of maternal deaths in industrialised countries [16]. Most maternal deaths from PPH are avoidable, and in 60 – 80% of all cases they are the result of major substandard care [16], [18] – [21]. It is especially important to be aware that the extent of bleeding will be underestimated by 30 – 50% if assessed visually [22] – [25].
The “4 Tʼs” is an English mnemonic used to summarise the causes of PPH (combinations of all four causes are the norm) ([Table 5]) [26]:
Cause |
Potential trigger |
---|---|
Tone (focal or diffuse uterine atony – responsible for at least 80% of PPHs [2]) |
Idiopathic atony Uterine overdistension (from multiparity, hydramnios, fetal macrosomia) Tocolytics Precipitate or delayed delivery/prolonged labour Oxytocin tachyphylaxis (after prolonged administration of oxytocin) Chorioamnionitis Uterine fibroids |
Tissue (placenta) |
Retained placenta Placenta accreta spectrum (morbidly adherent placenta, placenta accreta/increta/percreta) Placental remnants |
Trauma |
Vulvovaginal injuries Cervical tears Uterine tear from surgical extension of uterotomy Episiotomy/perineal tear Uterine rupture Uterine inversion |
Thrombin (coagulopathy) |
Pregnancy-induced: Disseminated intravascular coagulation (DIC) (e.g., with preeclampsia, HELLP syndrome, intrauterine fetal death [IUFD], placental abruption, amniotic fluid embolism) Other:
|
-
Tone (postpartum uterine atony),
-
Trauma (injury of the birth canal),
-
Tissue (retained placental tissue or detachment disorders),
-
Thrombin (coagulation decompensation, coagulopathy).
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2 Definition
Consensus-based recommendation 2.E1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
The following definition of PPH is recommended:
Irrespective of the visible blood loss, PPH must be assumed if the patient presents with clinical signs of haemorrhagic shock (shock index [HF/RRsys] > 0.9). |
Clinically, a blood loss of between 500 and 1500 is usually tolerated without symptoms of shock [27], [28]. Symptoms such as agitation, clouding of consciousness, cold sweat, paleness, tachycardia, hypotension, hyperventilation, and oliguria are already signs of severe haemorrhagic shock (shock index [HF/RRsys] > 0.9) [29], [30].
PPH is categorised into primary and secondary PPH, according to the time when it occurs [26]:
Primary (acute) bleeding:
-
usually occurs just a few hours postpartum (often already in the delivery room or operating room).
-
The cause is usually atony (> 80%) or trauma resulting in blood loss (e.g., occult intraabdominal or retroperitoneal bleeding).
-
Clinically this leads to haemodynamic derangement with a rapid decrease in blood pressure (hypovolaemia).
Secondary (subacute) bleeding/late postpartum bleeding:
-
Incidence: occurs in around 0.2 to 2.5% of postpartum women
-
Postpartum women often only start bleeding in the postpartum ward or at home.
-
Causes of this “secondary” PPH are usually placental remnants, subinvolution of the uterus or infection.
-
Clinically, this leads to haemodynamic derangement with tachycardia with a rapid decrease in blood pressure (hypovolaemic-haemorrhagic shock).
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3 Risk stratification and prevention
Consensus-based recommendation 3.E1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [31] |
|
On ultrasound scans performed in the 1st and 2nd trimester of pregnancy in high-risk cases (e.g., status post repeated caesarean section), the location and structure of the placenta may provide hints of a disorder of placentation. In cases with low lying placenta in the 2nd trimester presence of placenta praevia and/or vasa praevia should be ruled out and documented, if necessary by performing additional ultrasound examinations. |
Consensus-based recommendation 3.E2 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Especially in women with a history of risk factors (previous surgeries, esp. previous caesarean section and transmural myomectomy) or clinical findings such as placenta praevia, the presence of PAS should be considered. Further diagnostic ultrasound examinations may aid in the diagnostic work-up. |
A detailed medical history, diagnostic ultrasound examinations during prenatal care, estimation of the risk of bleeding, counselling and delivery planing in an appropriate maternity hospital, and timely preparations for an increased loss of blood may reduce the risk of PPH and its consequences for maternal morbidity and mortality [32].
The main risk management problems for PPH are [33], [34], [35], [36]:
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delayed diagnosis and/or therapy due to underestimation of the actual loss of blood,
-
delay in providing blood and coagulation products,
-
lack of or non-compliance with simple instructions,
-
lack of adequate training and further training,
-
inadequate or ineffective communication within the interdisciplinary team,
-
deficits in the organisational structure,
-
delay in implementing and realising treatment standards.
3.1 Risk factors for PPH
A number of risk factors for PPH have been identified. Risk factors can be categorized into sociodemographic and obstetric (based on previous history and current) risk factors ([Table 6]).
Blood loss |
OR or range |
|
---|---|---|
> 500 ml |
> 1000 ml |
|
Sociodemographic risk factors |
||
Obesity (BMI > 35) |
1.6 |
|
Maternal age (≥ 30 years) |
1.3 – 1.4 |
1.6 |
Obstetric risk factors |
||
Placenta praevia |
4 – 13.1 |
15.9 |
Premature placental detachment |
2.9 – 12.6 |
2.6 |
Retained placenta |
4.1 – 7.8 |
11.7 – 16.0 |
Prolonged placental stage |
7.6 |
|
Preeclampsia |
5.0 |
|
Multiple pregnancy |
2.3 – 4.5 |
2.6 |
Status post PPH |
3.0 – 3.6 |
|
Fetal macrosomia |
1.9 – 2.4 |
|
HELLP syndrome |
1.9 |
|
Hydramnios |
1.9 |
|
(Prolonged) oxytocin augmentation |
1.8 |
|
Induction of labour |
1.3 – 2 |
2.1 – 2.4 |
Protracted labour |
1.1 – 2 |
|
Fibroids |
||
Uterine malformations |
||
Grand multiparity |
||
Surgical risk factors |
||
Emergency caesarean section |
3.6 |
|
Elective caesarean section |
2.5 |
|
Operative vaginal birth |
1.8 – 1.9 |
|
Episiotomy |
1.7 – 2.21 |
2.07 |
Perineal tear |
1.7 |
2.5 |
Other risk factors |
||
Antepartum bleeding |
3.8 |
|
Von Willebrand syndrome (esp. types 2 and 3) |
3.3 |
|
Anaemia (< 9 g/dl) |
2.2 |
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3.2 Risk stratification
A general risk stratification to predict PPH (e.g., using a score) does not currently exist and is not recommended for use in practice.
Known risk factors – particularly those associated with a high relative risk of PPH – must be considered on a case-by-case basis when taking the relevant preventive (e.g., organisational) steps [26].
Recent reports have confirmed the purpose and benefit of standardised treatment algorithms and their review during regular audits [32], [38], [39]. An interdisciplinary (anaesthesiology and intensive care medicine, obstetrics) algorithm, known as the PPH 2022 algorithm, has been developed as a transnational algorithm for Germany, Austria, and Switzerland ([Fig. 1]) [26].
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3.3 Placental detachment disorders: placenta praevia/placenta accreta spectrum (PAS)
3.3.1 Placenta praevia
Consensus-based statement 3.S1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
A previous caesarean section is associated with a higher risk of placenta praevia in subsequent pregnancies. The risk increases with the number of deliveries by caesarean section. The risk of placenta praevia is also higher following curettage (e.g., termination of pregnancy, miscarriage) or multiple pregnancies. |
Consensus-based statement 3.S2 |
|
---|---|
Expert consensus |
Level of consensus +++ |
In vitro fertilisation (IVF) procedures increase the risk of placenta praevia. |
Consensus-based statement 3.S3 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [48] |
|
Nicotine abuse increases the risk of placenta praevia. |
3.3.1.1 Diagnosing placenta praevia
Consensus-based recommendation 3.E3 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Ultrasound examination in the 2nd trimester of pregnancy must determine and record the location, structure and umbilical cord insertion site of the placenta. If ultrasound examination shows a low-lying placenta, placenta praevia should be excluded and the patient should be investigated for vasa praevia, if necessary, by performing another ultrasound examination; ultrasound findings should be documented. |
Consensus-based recommendation 3.E4 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [50] |
|
If ultrasound examination in the 2nd trimester of pregnancy shows a low-lying placenta (≤ 20 mm distant from the internal cervical os) or placenta praevia, another assessment of the placental location must be carried out to confirm the diagnosis at 28 + 0 weeks of gestation and, if necessary, at 32 + 0 weeks of gestation. |
Consensus-based recommendation 3.E5 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Transvaginal ultrasound assessment must be carried out if there is a suspicion of placenta praevia, vasa praevia or placenta accreta spectrum. |
Consensus-based statement 3.S4 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [50] |
|
Transvaginal ultrasound is the gold standard to diagnose placenta praevia (sensitivity 87.5%, specificity 98.8%, PPV 93.3%, NPV 97.6%). |
Consensus-based recommendation 3.E6 |
|
---|---|
Expert consensus |
Level of consensus +++ |
In cases with placenta praevia, measurement of cervical length may be used to plan further management in asymptomatic pregnant women. A short cervix before 34 + 0 weeks of gestation increases the risk of emergency C-section and massive PPH. In principle, if placenta praevia totalis has been confirmed, inpatient admission should be considered from week 24 + 0 of gestation. |
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3.3.2 Placenta accreta spectrum (PAS)
Disorders of placental implantation are currently grouped together under the term PAS (placenta accreta spectrum).
Consensus-based statement 3.S5 |
|
---|---|
Expert consensus |
Level of consensus +++ |
The main risk factors for PAS are disorders of placental implantation in a previous pregnancy, previous caesarean section, and other uterine surgeries (e.g., transmural myomectomy). The risk increases with the number of previous caesarean sections. Placenta praevia is an independent risk factor for PAS. |
Consensus-based recommendation 3.E7 |
|
---|---|
Expert consensus |
Level of consensus +++ |
In principle, pregnant women with suspected disorders of placentation must present early to a maternity hospital with a suitable organisational structure where, if the suspicion is confirmed, the patient should be treated by an experienced multidisciplinary team (“at the optimum time by the best team”). |
3.3.2.1 Diagnosing placenta accreta spectrum
Consensus-based statement 3.S6 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [50] |
|
If PAS is suspected antenatally, taking the appropriate steps will reduce maternal morbidity and mortality. |
Population studies have shown that PAS was not recognised prenatally in 50 – 66% of cases [57], [60]; even specialised centres do not detect around ⅓ of cases prenatally [61].
Consensus-based recommendation 3.E8 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Implantation disorders (placenta accreta spectrum) must be considered, especially if the patientʼs medical history indicate that she has a high risk of PAS (previous surgeries) or examination findings (placenta praevia) show that the patient is at high risk. |
3.3.2.1.1 (Doppler) sonography
Consensus-based recommendation 3.E9 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
A detailed ultrasound examination must be carried out if PAS is suspected. Additional MRI may be considered in cases where the findings are unclear. |
Consensus-based statement 3.S7 |
|
---|---|
Expert consensus |
Level of consensus +++ |
As the majority of PAS are a consequence of low-lying implantation of the placenta in the area of the caesarean section scar, transvaginal ultrasound examination in the 1st and 2nd trimester of pregnancy may contribute to early (suspected) diagnosis and direct the further management of the patient. |
Sonographic signs of PAS include the following (not all of which must always be detectable) ([Table 7]).
Ultrasound findings |
Description |
---|---|
B-mode image |
|
Loss of clear zone |
Loss or irregularity of the hypoechoic retroplacental clear zone in the myometrium beneath the placental bed |
“Moth-eaten” lacunae |
Image shows numerous irregular (“moth-eaten”) lacunae, some of which show turbulent flow in B-mode, typically perpendicular at the uterovesical interface |
Bladder wall interruption |
Loss or irregularity of the hyperechoic layer of the bladder wall |
Myometrial thinning |
Thinning (< 1 mm) or loss of myometrium in the area of the placenta |
Placental bulge |
Outpouching of the uterine serosa from the expected plane, caused by abnormal placental tissue, although the serosa appears intact |
Focal exophytic placental tissue |
Placental tissue breaks through the uterine serosa (e.g., into the bladder) |
Doppler sonography |
|
Uterovesical hypervascularity |
Increased imaging of irregular vascular perfusion between the myometrium and the posterior wall of the bladder (numerous spiral vessels with bidirectional flow) |
Subplacental hypervascularity |
Increased imaging of irregular vascular perfusion in the placental bed (numerous spiral vessels with bidirectional flow) |
Bridging vessels |
Imaging of vessels which extend from the placenta through the myometrium and serosa into the bladder or other organs – often perpendicular to the myometrium |
Afferent vessels to the placental lacunae |
Vessels with high velocity of blood flow from the myometrium to the lacunae |
3-D Doppler sonography |
|
Intraplacental hypervascularity (power Doppler) |
Complex irregular placental vessels with tortuous courses |
3.3.2.1.2 Magnetic resonanc imaging (MRI)
Consensus-based statement 3.S8 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
MRI examinations are not routinely carried out to diagnose PAS but may offer additional information in cases where findings are inconclusive. |
Consensus-based recommendation 3.E10 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Contrast media (gadolinium) must not be routinely used to diagnose PAS. |
3.3.2.1.3 Biomarkers
Consensus-based recommendation 3.E11 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Biomarkers must only be used during diagnostic investigations for PAS in the context of registered clinical studies. |
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4 Prevention of PPH
4.1 Prevention of PPH during vaginal delivery
4.1.1 Active management of the third stage of labour in vaginal deliveries
Consensus-based recommendation 4.E1 |
|
---|---|
Expert consensus |
Level of consensus ++ |
Active management of third stage of labour (AMTSL) reduces the risk of PPH by up to 66% and must therefore be recommended for every delivery. |
The most decisive step consists of the prophylactic administration of uterotonic drugs [75], [76]; basically, it is important to ensure the following [26]:
-
provide antenatal information about management in the third stage of labour and take the wishes of the pregnant woman into consideration (consent).
-
it is important to allow the mother (and her birth companion) and the neonate to get to know each other (bonding); this promotes the endogenous release of oxytocin and should be facilitated so that they can be undisturbed – as long as the situation permits – during the first hour together.
Consensus-based recommendation 4.E2 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
During vaginal delivery, early clamping and cutting of the umbilical cord immediately after the delivery of the neonate accompanied by controlled traction on the umbilical cord does not reduce postpartum haemorrhage and should not be carried out. |
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4.1.2 Medication prophylaxis against PPH
4.1.2.1 Uterotonic drugs
Consensus-based recommendation 4.E3 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Oxytocin 3 – 5 IU IV or carbetocin 100 µg IV (both administered by short infusion) may be used for medication prophylaxis against PPH or administered IM in cases of vaginal delivery; carbetocin is effective for longer and has the same side-effects rate. |
4.1.2.1.1 Oxytocin/carbetocin
When oxytocin or carbetocin are administered IV, it is important to remember that a quick (bolus) injection will lead to a decrease in blood pressure with reflex tachycardia [77], [78]. That is why these agents should be administered by short infusion; a slow IV injection may be necessary. Alternatively, both oxytocin and carbetocin may be administered IM.
4.1.2.1.2 Methylergometrine
Consensus-based recommendation 4.E4 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Methylergometrine has more side effects than oxytocin and carbetocin, and should therefore not be administered as a first choice medication. |
4.1.2.1.3 Misoprostol
Consensus-based recommendation 4.E5 |
|
---|---|
Expert consensus |
Level of consensus +++ |
References: [26] |
|
Misoprostol is less effective than oxytocin and carbetocin and should therefore not be administered as a first choice medication. |
4.1.2.1.4 Antifibrinolytic agents
Consensus-based recommendation 4.E6 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Tranexamic acid must not be routinely used for bleeding prophylaxis but only therapeutically following a diagnosis of PPH. |
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4.2 Prevention of PPH during caesarean section
Consensus-based recommendation 4.E7 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Similar to vaginal deliveries, medication must be administered as a prophylaxis against PPH in every caesarean section delivery. As with vaginal births, oxytocin 3 – 5 IU IV or carbetocin 100 µg IV may be administered (both by short infusion); carbetocin is effective for a longer period and has the same side-effects rate. |
#
4.3 Prevention when risk factors are present
Consensus-based recommendation 4.E8 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
In hospital, the following measures must be implemented before inducing labour if the patient has known risk factors:
Check logistics:
Availability of coagulation factors, fibrinogen, factor XIII, recombinant Factor VIIa (rFVIIa). |
#
#
5 General (emergency) measures and diagnostic steps to determine causes
5.1 Estimating the severity of bleeding
Consensus-based statement 5.S1 |
|
---|---|
Expert consensus |
Level of consensus ++ |
Visual estimates of blood loss are inaccurate. Validated measurement methods to determine the extent of blood loss should be preferred. |
Consensus-based recommendation 5.E1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
All underlays, pads, linen “soaked” with blood and all coagula must be collected and weighed if the bleeding increases/in cases with PPH. |
Consensus-based recommendation 5.E2 |
|
---|---|
Expert consensus |
Level of consensus +++ |
The patientʼs clinical symptoms (signs of hypovolaemia) must be considered when estimating the extent of blood loss: shock index (HF/RRsys) > 0.9. |
Consensus-based recommendation 5.E3 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
When caring for a bleeding patient, Hb values must be checked in good time and regularly; it is important to be aware that Hb levels will be slow to respond and cannot replace gravimetric measurements. Early signs of critical hypovolaemia may include reduced base excess (BE) levels in venous blood gas analysis and elevated lactate levels. Alarming signs: BE < −6 mmol/l and lactate > 4 mmol/l. |
#
5.2 Communication and multidisciplinary teams
Consensus-based statement 5.S2 |
|
---|---|
Expert consensus |
Level of consensus ++ |
Reference: [26] |
|
From the start, the woman giving birth/postpartum woman and her companion(s) must be informed about the bleeding and the approach taken in words that can be understood by laypersons. |
Consensus-based recommendation 5.E4 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Depending on the situation/the loss of blood, experienced midwives and obstetricians as well as the anaesthesiologist and other medical specialists must be informed and consulted (see PPH algorithm, [Fig. 1]). |
#
5.3 General measures against PPH
Consensus-based statement 5.S3 |
|
---|---|
Expert consensus |
Level of consensus +++ |
In addition to general measures (for haemodynamic stabilisation or uterine compression → Hamilton procedure), treatment of PPH consists of the appropriate drug therapy and/or surgical and/or interventional therapy which must be quick, coordinated, and often performed simultaneously (see PPH algorithm, [Fig. 1]). |
#
#
6 Pharmaceutical therapy to treat PPH
6.1 Uterotonic drugs
6.1.1 Oxytocin IV (poss. IM)
Consensus-based recommendation 6.E1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Oxytocin must be used as first-line therapy for primary PPH. Compared to misoprostol, oxytocin is more effective, particularly after vaginal birth, and has fewer side effects. Overall, a maximum of 6 – 10 IU may be administered as a short infusion:
|
The onset of effect following IV administration occurs (with a half-life period of around 10 min outside pregnancy and 3 – 4 min in pregnant women) within one minute; following intramuscular administration, (a maximum of 10 IU) it occurs within 3 – 5 minutes [95].
#
6.1.2 Carbetocin
The therapeutic use of carbetocin to treat PPH is an off-label use, as it has currently not yet been sufficiently validated in studies. The administration of carbetocin to treat PPH has been reported in individual cases.
#
6.1.3 Methylergometrine
Consensus-based recommendation 6.E3 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Because of its range of side effects, methylergometrine should not be used to manage postpartum bleeding as other alternatives are available in Europe. |
#
6.1.4 Prostaglandins
Consensus-based recommendation 6.E4 |
|
---|---|
Expert consensus |
Level of consensus +++ |
If first-line uterotonic drugs fail or the patient does not respond, medication must be switched without delay to prostaglandins. The use of sulprostone is recommended because of its favourable efficacy profile and relatively limited side effects. |
Consensus-based recommendation 6.E5 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Oxytocin receptor agonists and prostaglandins should not be administered at the same time. If a rapid transition from oxytocin receptor agonists to sulprostone is necessary for clinical reasons, the cardiovascular side effects should be carefully monitored. |
If first-line uterotonic drugs fail or the patient does not respond to them, medication must be switched to prostaglandins without delay; it is not necessary to observe a time gap/pause (particularly when administering carbetocin) between medications.
6.1.4.1 Sulprostone
Consensus-based recommendation 6.E6 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Sulprostone must be exclusively administered intravenously (infusion pump/syringe driver). Because it is difficult to control, intramuscular or intramyometrial administration must be avoided. |
The following de-escalating regimen to administer sulprostone has been found to be useful for the clinical management of PPH (recommendation of the guideline authors):
-
dosage 500 µg in 500 ml carrier fluid (via an infusion pump)
-
de-escalating run time, i.e.
-
3 min at 500 ml/h or 8.3 ml/min (8.3 µg/min), then
-
7 min at 100 ml/h or 1.7 ml/min (1.7 µg/min),
-
followed by 10 – 20 ml/h or 0.2 – 0.4 ml/min
-
-
max. 1500 µg/d
#
6.1.4.2 Misoprostol
Consensus-based statement 6.S1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Because of its delayed onset of action and the availability of better approved alternatives, misoprostol is not suitable for the treatment of persistent PPH. |
The use of misoprostol may be considered (off-label use!) to treat moderately persistent PPH after administering oxytocin; however, the current data are not sufficient to permit a final recommendation to be made.
#
6.1.4.3 Intrauterine administration of prostaglandins
Consensus-based recommendation 6.E7 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Sulprostone must not be administered by intramyometrial or intracervical application. |
#
#
#
6.2 Antifibrinolytic drugs (tranexamic acid)
Consensus-based recommendation 6.E2 |
|
---|---|
Expert consensus |
Level of consensus +++ |
After PPH is diagnosed, tranexamic acid 1 g IV must be administered at the same time as oxytocin receptor agonists are administered, without a prior coagulation analysis. The earlier tranexamic acid is administered, the more effective it will be. |
#
#
7 Uterine tamponade
In addition to other second-line treatment strategies, uterine tamponade may significantly reduce the rate of emergency hysterectomies [103], [104], [105].
Different balloon systems (approved systems: Bakri balloon, ebb Complete Tamponade System) are available for uterine tamponade, in addition to tamponade strips. Their efficacy has been confirmed in different publications and they offer the advantage that persistent bleeding is recognised early [105], [106], [107], [108], [109], [110], [111], [112], [113], [114], [115].
There have been several recent case series reporting on the use of gauze (Celox) coated with a haemostatic agent (chitosan), originally developed for emergency and military medicine, as an intrauterine tamponade to manage PPH. The use of this type of gauze should be preferred to a simple gauze tamponade, especially for anticoagulation [116] – [118]. In November 2022, the manufacturer reported that Celox PPH, a special variant of Celox, was CE certified.
In recent years, more reports on the use of uterine packing, i.e., uterine tamponade with gauze have been published [105], [107], [119]. Potential drawbacks include possible occult bleeding as well as bleeding on removal and, potentially, pain when removing the tamponade.
Vacuum-induced uterine tamponade is a method which has not yet been widely used in German-speaking countries [120] – [126].
A combination of different tamponade methods with uterine compression sutures, similar to a “sandwich technique,” have been successfully used in different case series [127], [128], [129], [130].
Consensus-based recommendation 7.E1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Uterine tamponade, irrespective of the chosen method, does not exclude the use of other potentially necessary therapeutic options such as compression sutures; they are urgently recommended when treating atony. |
#
8 Surgical measures
8.1 Bridging interdisciplinary measures
In the event of the lethal triad of persistent bleeding, haemorrhagic shock and coagulopathy, the recommended approach must be damage control surgery, carried out in three stages [134], [135]:
-
Surgical haemostasis carried out within an acceptable time frame using a Pfannenstiel incision or median laparotomy, eventration of the uterus with cranial traction and uterine compression and atraumatic clamping of the uterine arteries to minimise perfusion. Placement of uterine compression sutures and application of a uterine tamponade.
-
In parallel, anaesthetic and intensive care measures performed to correct hypovolaemia, hypothermia, acidosis and coagulopathy; if necessary, surgery must be paused until the patient is stable.
-
Definitive (surgical) treatment of the now haemodynamically stabilised patient by a surgeon with the appropriate surgical expertise. If the infrastructure is available, one option may be interventional radiological embolization of the afferent uterine arteries [136], [137].
Consensus-based recommendation 8.E1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Bimanual compression of the aorta for up to 20 minutes may be carried out during the “bridging period” to avoid unnecessary loss of blood. If it is foreseeable that the bleeding cannot be controlled by a hysterectomy or if the bleeding continues despite performing a hysterectomy, packing of the pelvis and abdomen should be carried out using a sufficient number of moistened abdominal bandages. If interventional radiological measures can be carried out, temporary balloon occlusion of the aorta may be performed. |
#
8.2 Compression sutures
Consensus-based recommendation 8.E2 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Appropriate suturing materials (large needle, long sutures) must be kept on hand in operating rooms for uterine compression sutures. |
In the last 15 years, the range of surgical treatment options has been significantly expanded by the use of uterine compression sutures [142]. This method aims to compress the uterus and reduce the size of the placental adhesion surface, creating a tamponade at the bleeding site.
It is currently not possible to make a statement about the optimal efficacy of any specific method; a suitable suturing technique should be used according to the indication (atony, bleeding from the placental bed, diffuse bleeding) [26], [143].
#
8.3 Vascular ligations
In addition to simple ligation of the uterine artery, stepwise uterine devascularisation may also be carried out. This technique consists of five consecutive steps to ligate the ascending and descending branches of the uterine arteries and collateral branches of the ovarian artery [144], [145].
Consensus-based recommendation 8.E3 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Ligation of the internal iliac artery must only be carried out as an ultima ratio and only by a surgeon with extensive experience of pelvic surgery. |
#
8.4 Postpartum hysterectomy
Consensus-based recommendation 8.E4 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Conservative measures to preserve the uterus are only reasonable as long as the patient is haemodynamically stable and bleeding is not life-threatening. If a hysterectomy is necessary, the decision should not be delayed. |
Consensus-based recommendation 8.E5 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Supracervical hysterectomy should be preferred in cases with atony as the operating time is significantly shorter and it does not result in unintended shortening of the vagina. Total hysterectomy may be considered in cases with placental implantation disorders or cases with injuries of the lower uterine segment; imaging of the ureters is recommended in these cases. |
Relative contraindications for uterus-preserving measures include:
-
extensive placental implantation disorders (placenta increta/percreta) where the placental implantation bed is open, bleeding at the placental implantation bed does not respond to therapy or the placental implantation bed covers large areas of the uterine wall,
-
non-reconstructable uterine injury,
-
septic uterus.
#
#
9 Interventional radiological procedures: transarterial techniques
-
temporary/intermittent balloon occlusion of the iliac arteries
-
temporary/intermittent balloon occlusion of the aorta
-
embolization of the uterine arteries
Consensus-based recommendation 9.E1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Every obstetric department must ascertain which interventional radiological procedures are available to treat PPH. If these procedures can be carried out in-house or locally, an appropriate interdisciplinary treatment pathway should be agreed on, which will include the use of interventional radiological techniques at an early stage after conservative measures have been exhausted. |
Consensus-based recommendation 9.E2 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
If a radiological procedure/treatment is indicated, the radiology department should be informed early on (e.g., if haemostasis is unsuccessful after placing uterine compression sutures). |
Consensus-based recommendation 9.E3 |
|
---|---|
Expert consensus |
Level of consensus ++ |
Reference: [26] |
|
Other treatment options should be largely exhausted prior to carrying out interventional radiological treatment. |
Consensus-based recommendation 9.E4 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
If the procedure can be planned (e.g., in cases with placenta accreta spectrum), vascular access and placement of the occlusion balloon may already be carried out preoperatively. |
#
10 Haemostasis and coagulation management
10.1 Background
Consensus-based statement 10.S1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
The leading causes of PPH are atony, traumatic injury, placental remnants, and coagulation disorders. It is rare for a primary coagulation disorder (coagulopathy) to be the cause of PPH. The coagulopathy is usually acquired during PPH ([Fig. 2]). |
According to the concept of the 4 Tʼs, atony, placental retention, and vascular lesions accompanied by increased fibrinolytic activity are the most important causes of PPH. If early treatment of the cause is unsuccessful, persistent PPH will always result in a coagulopathy, irrespective of the original cause [148], [149], [150].
The larger the volume of replacement fluids, the worse the coagulation parameters will be [151]. Orientating perioperative levels for haemodynamic stability are BE > −6 mEq/l, lactate < 4 mmol/l and pCO2 gap < 6 mmHg [152].
Consensus-based recommendation 10.E1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
All hospitals with obstetric departments must develop a treatment algorithm for the peripartum/postpartum period which is adapted to the conditions in the respective hospital. The focus must be on early diagnosis and the targeted treatment of bleeding. The algorithm must define the approach used for treatment and include all available treatment options including pharmacological, haemostatic, radiological interventions, and surgical measures. |
#
10.2 Options to treat peri-/postpartum coagulopathic bleeding
Consensus-based recommendation 10.E2 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
In cases with active bleeding, iatrogenic aggravation of the tendency to bleed must be avoided, e.g., artificial colloidal volume replacement solutions should be avoided, as they have a strong dilutional and coagulopathic effect. |
Consensus-based statement 10.S2 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Standard haemostatic therapy to treat severe peripartum bleeding consists of the early administration of tranexamic acid, coagulation factor concentrates and/or fresh frozen plasma with coagulation factors (FFP) to avoid an additional dilutional coagulopathy in addition to the ongoing loss of blood. |
Consensus-based recommendation 10.E3 |
|
---|---|
Expert consensus |
Level of consensus +++ |
In cases with persistent bleeding, evidence of a lack of coagulation factors is useful to determine the appropriate targeted therapy. Evidence for coagulation factor deficiencies should be obtained from laboratory parameters (e.g., hemogram, blood gas analysis [BGA], aPTT, Quick or INR and, if available, fibrinogen, factor XIII, and viscoelastic tests [VET]). |
In addition to primary haemostasis, recent data have shown that when treating patients with peripartum bleeding, in addition to fibrinogen [37], [91], the focus must also be on other components of the final steps of the coagulation pathway [157], [158]. It is important to ensure a balanced replacement of all components involved in cases with a specifically identified or anticipated deficiency (justifiable targets: FXIII > 60% [157], [158], platelets 70 – 100 Gpt/l [159], fibrinogen > 2 – 2.5 g/l [160], [161], [162]).
Consensus-based recommendation 10.E4 |
|
---|---|
Expert consensus |
Level of consensus +++ |
To begin with, any existing increased fibrinolytic activity must be treated by the administration of tranexamic acid (antifibrinolytic agent) before administering procoagulant factors (platelets, fibrinogen, FXIII, PPSB). For dosage recommendations, see recommendation 10.E6. |
Consensus-based recommendation 10.E5 |
|
---|---|
Expert consensus |
Level of consensus ++ |
References: [26], [91], [154], [155], [159], [163], [164], [165], [166], [167], [168], [169] * Note: After the procedure to achieve consensus had been concluded/AWMF guideline 015/063 had been submitted, the official approval for recombinant Factor VIIa (rFVIIa) was expanded to include its use to treat “severe postpartum bleeding when uterotonic drugs are not sufficient to achieve haemostasis”. In this expanded official approval, the use of rFVIIa was proposed for patients who failed to respond to sulprostone, with a proposed rFVIIa dosage of 60 – 90 µg/kg; this should take effect within 10 minutes; a possible second dose may be administered after 30 minutes [170]. Without postponing the publication date of the guideline, the guidelines commission was unable to evaluate all of the published data on the use of rFVIIa in patients with severe PPH who do not respond to uterotonic drugs. The decision was therefore taken not to change the current recommendation regarding the use of rFVIIa as a last resort for patients with severe refractory PPH who do not respond to all other treatment options, and to evaluate the literature on the use of rFVIIa in any subsequent revision of the guideline. |
|
Recommendations for the haemostatic management of persistent PPH requiring substitution are:
For dosage recommendations, see recommendation 10.E6. |
There are currently no reliable data which would permit an evidence-based recommendation to be made on the use of DDAVP (desmopressin) in obstetrics as an acute therapy to treat bleeding [171], even though a positive effect has been repeatedly observed [172].
DDAVP must only be administered under the following conditions [26]:
-
only for thrombopathies known to respond to DDAVP (consultation with the haemostasiology department recommended!)
-
not to patients with known “sub”-haemophilia A (i.e., carriers for haemophilia A)
-
not to patients known to have von Willebrand syndrome type 1
-
after umbilical cord clamping and cutting
Consensus-based recommendation 10.E6 |
||
---|---|---|
Expert consensus |
Level of consensus ++ |
|
Reference: [26] |
||
1 |
Stabilisation of the patientʼs general condition (prophylaxis and therapy!) |
Core temperature ≥ 34 °C (ideally normothermia) pH ≥ 7.2 ionised Ca++ concentration > 0.9 mmol/l (ideally normocalcemia) |
2 |
Inhibition of potential hyper-fibrinolytic activity (always before administering fibrinogen and/or fresh frozen plasma) |
Tranexamic acid initially 1 g If needed, one repeat dose |
3 |
Substitution of oxygen carriers |
RBC administration haemostatic goal in cases with severe bleeding: Hb ca. 7 – 9 g/dl (4.3 – 5.5 mmol/l) |
4 |
Substitution of coagulation factors (for persistent increased bleeding tendency) depending on availability in the hospital Patients who (will) require massive transfusions or who are suffering from haemorrhagic life-threatening shock may benefit from a high ratio of FFP : RBC : PC, for example, 4 (to 6) to 4 (to 6) to 1, or combined administration of plasma and factor concentrates as well as platelet concentrates |
Fibrinogen 30 – 60 mg/kg BW, goal: ≥ 2 – 2.5 g/l and FXIII 20 IU/kg BW, goal: FXIII activity > 60% or FFP ≥ 30 ml/kg BW or PPSB initially 25 IU/kg BW |
5 |
Replace plasma volume |
FFP ≥ 30 ml/kg BW |
6 |
Platelet substitution for primary haemostasis |
Platelet concentrates (for persistent bleeding requiring transfusion; goal: ≥ 70 – 100 Gpt/l) |
7 |
If necessary, a “thrombin burst” with platelet and coagulation activation (consider haemostatic conditions!) |
In individual cases: ggf. rFVIIa initial 60(– 90) µg/kg BW |
Caution:
|
Consensus-based statement 10.S2 |
|
---|---|
Expert consensus |
Level of consensus +++ |
There is an increased risk of thromboembolism after haemostasis due to reduced antithrombin activity (in some instances, absolute activity < 50%). This necessitates thrombosis prophylaxis within 24 hours; in cases with risk factors, thrombosis prophylaxis should be continued for up to 6 weeks postpartum. |
Consensus-based recommendation 10.E7 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Antithrombin activity may be determined in the intensive care unit and substitution may be considered after cessation of bleeding, especially after administering concentrates of individual coagulation factors or complex preparations (especially PPSB). |
#
10.3 Anaesthesia-related aspects of managing PPH
Consensus-based recommendation 10.E8 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
A timely call for expert assistance should be considered when blood loss is more than 1000 ml and expert assistance must be called in when persistent blood loss is 1500 ml. |
Consensus-based recommendation 10.E9 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Haemodynamic stability must be maintained or achieved during PPH. Needs-based volume replacement therapy must be carried out with careful monitoring of volumes to avoid iatrogenic over-infusion. The haemodynamic response to the administered fluid volume must be monitored. |
Consensus-based recommendation 10.E10 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Secure the airways and ensure a sufficient oxygen supply to patients receiving regional anaesthesia (spinal anaesthesia, epidural anaesthesia): early intubation should be considered for a blood loss of ≥ 1500 ml with signs of persistent bleeding. If there is a loss of protective reflexes, endotracheal intubation to secure the airways and ensure a sufficient oxygen supply must take priority. |
Consensus-based recommendation 10.E11 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Large-lumen access points (2 × ≥ 16 G) must be placed; arterial blood pressure measurement should be carried out as a secondary measure, if needed; when in doubt, create a wide-lumen central (≥ 9 Fr) access and use a massive transfusion unit. |
Consensus-based recommendation 10.E12 |
|
---|---|
Expert consensus |
Level of consensus +++ |
After cessation of bleeding, intravenous (or oral) iron substitution may be carried out according to local conditions to compensate for the iron deficiency as evidenced by laboratory analysis (soluble transferrin receptor or ferritin < 100 ug/l and transferrin saturation < 20%) or decreased haemoglobin levels (< 9.5 g/dl). |
10.3.1 Mechanical autotransfusion (MAT) for PPH
Consensus-based recommendation 10.E13 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Mechanical autotransfusion should be considered for patients with increased risk of bleeding. |
-
National recommendations and international guidelines recommend mechanical autotransfusion for patients with severe PPH (CMACE, NICE, OAA/AAGBI, ESAIC).
-
Only after amniotic fluid has been suctioned and the infant has been delivered [182].
-
Initially, only “collect” (i.e., create a reservoir); carry out “washing” if needed (i.e., additional suction system with tubing); in such cases, standard use of autotransfusion may also be cost-effective [183], [184].
-
Auto-transfused blood contains no coagulation factors or platelets; coagulation factors should be substituted to avoid coagulopathy following high transfusion volumes [185].
-
Use of leukocyte depletion filters has been recommended based on theoretical considerations. Recent studies do not consider this to be necessary [183], [184], [186].
-
Standard use of autotransfusion in all caesarean section results in re-transfusion volumes of around 250 ml [183], [184]; the use of autotransfusion can therefore only be recommended for patients with a high risk of bleeding.
-
We recommend obtaining a guarantee from the respective manufacturer of the device that the unit will wash out tissue-factor-containing amniotic fluid/placental tissue.
#
#
10.4 Benefit of diagnostics using a point-of-care (PoC) approach and standard lab tests for coagulation analysis
Consensus-based statement 10.S3 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Treatment with coagulation factors or platelets is indicated for patients with persistent severe peripartum bleeding (> 1500 ml) and evidence for a deficiency of coagulation factors or platelets. |
Time plays an essential role in the diagnosis and treatment of PPH [187]. A deficiency of one or more coagulation factors can be diagnosed with parameters obtained by standard coagulation laboratory tests and viscoelastic tests (VET). However, standard laboratory/VET values are mainly useful to decide when substitution is not required [188]. The preventive administration of fibrinogen is not useful, not even in an obstetric setting [189].
#
#
11 Treatment algorithms
11.1 Atony
-
Anticipate risk factors
-
Diagnosis: increased fundal height; soft, relaxed uterus; usually intermittent surge-like bleeding
-
Empty the bladder!
-
Mechanical procedures: uterine massage (endogenous prostaglandin formation), bimanual uterine compression (e.g., Hamiltonʼs procedure)
Caution:
-
500 – 1000 ml of blood may collect in the uterine cavity → discrepancy between externally apparent level of bleeding and development of a serious loss of volume. In cases of uncertainty, attempt rapid clarification using ultrasound as long as this does not lead to delay
-
Exclude birth trauma (speculum examination and abdominal US, if necessary)
-
Exclude placental remnants (check placenta for completeness, ultrasound)
Consensus-based recommendation 11.E1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Treatment plan for atony:
|
#
11.2 Placenta accreta spectrum
-
Anticipate risk factors (previous uterine surgery/curettage); in patients with prenatal suspicion of placentation disorder → care by a multidisciplinary team
-
The management of placental detachment disorders depends on the time of diagnosis and the mode of delivery.
-
Early interdisciplinary discussion/treatment plan is advisable.
Consensus-based statement 11.S1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Important cornerstones when managing PAS! The treatment plan of a pregnant woman with PAS includes:
If these conditions cannot be met: the pregnant woman must be presented to a suitable centre. |
Consensus-based recommendation 11.E2 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Management recommendations for PAS:
Management for elective delivery:
|
11.2.1.1 Extensive findings
-
Caesarean section with hysterectomy, preferably without a prior attempt to deliver the placenta (total HE preferred)
-
Alternatives:
-
Delayed hysterectomy following caesarean section if necessary
-
In individual cases, consider delaying delivery of the placenta (ideally in a centre with 24-h availability of an interdisciplinary surgical intensive care ward).
-
#
11.2.1.2 Focal findings
-
Partial resection of the uterine wall while retaining the uterus in cases with locally limited implantation disorder.
-
Focal intracavitary Z-sutures to achieve haemostasis in small areas of bleeding.
-
Interventional radiology if necessary: prophylactic occlusion of the internal iliac arteries [193], [194].
#
11.2.2 Management following antenatal diagnosis
Consensus-based recommendation 11.E3 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Pregnant women with suspected PAS (with/without placenta praevia) must be delivered in a perinatal centre with the relevant interdisciplinary expertise in managing PAS. Prenatal early presentation of the patient to the centre is strongly recommended. |
#
11.2.3 Management with intrapartum diagnosis
11.2.3.1 Vaginal birth
In cases where the placenta fails to detach and bleeding is present → ultrasound evaluation and manual separation of the placenta, followed by curettage with intraoperative ultrasound monitoring, if necessary.
If severe bleeding from the placental bed persists → surgical treatment; alternatively, embolization of the uterine arteries.
#
11.2.3.2 Caesarean section
Consensus-based recommendation 11.E4 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
If diagnosed intraoperatively and mother and child are stable, emergency transportation of the patient to a centre with the relevant expertise should be considered. If this is not possible, care by the best experts available must be ensured without delay. |
Do not manipulate the placenta if possible or attempt manual separation of the placenta!
Perform caesarean section with hysterectomy or alternatively delay delivery of the placenta (ideally in a centre with 24-h availability of an interdisciplinary surgical intensive care ward).
#
#
#
11.3 Uterine inversion
-
Uterine inversion may occur both with vaginal delivery and caesarean section (caused by the uterotomy).
-
Vaginal palpation: inverted intravaginal fundus.
-
Abdominal palpation: no fundal resistance, cuplike invagination may be palpated.
-
If the findings are not clear → ultrasound examination [195], [196].
Consensus-based recommendation 11.E5 |
|
---|---|
Expert consensus |
Level of consensus +++ |
References: [26], [197], [198], [199] (For images of the manoeuvres, see [26]) |
|
The goal is to reposition the uterus and treat the symptoms of haemorrhagic shock; The following measures must be carried out immediately after diagnosis and in the order given below:
|
#
#
12 Transportation
Consensus-based recommendation 12.E1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
The facility transferring the patient and the facility accepting the patient should have already agreed on the timing of transportation and staff coverage during transportation in the run-up to the transfer and the agreement between the two facilities should be recorded in writing. |
Consensus-based recommendation 12.E2 |
|
---|---|
Expert consensus |
Level of consensus +++ |
References: [26] |
|
Transportation of a haemodynamically instable patient as part of the management of PPH should be weighed up carefully and depend on the organisational conditions in the facility providing care. The patient should preferably only be transferred after haemodynamic stabilisation. |
12.1 Recommendations for managing the interface between non-hospital-based
obstetric care/
hospital in cases with PPH
-
Specific plans and arrangements must be agreed upon between the persons/facilities providing care (home-birth midwife, midwifery-led unit, hospital staff) before an emergency occurs and developed during joint team meetings or training courses. Arrangements must include professional exchanges on how the patient will be transported (who will be informed, how, and by whom) as well as the specific situation when handing over the patient (how will the patient be handed over and how will further communications be made).
-
A joint approach to the transportation of patients should be agreed upon beforehand and should be communicated to the relevant regional institutions beforehand, including to the rescue coordination centre (description of procedures, emergency telephone numbers, contact persons).
-
Jointly agreed terms, for example: “Acute danger to life of mother and/or child”, the specific diagnosis (e.g., placental abruption, PPH), “Please inform on-call consultants and staff”, “Please ensure the operating team is in readiness”, etc., ensure that communications will be effective and make it easier for the hospital to prepare for the emergency.
-
Carry out a joint case review after an emergency which includes all persons providing care during the emergency to continually improve and optimise cooperation between non-hospital-based and hospital-based obstetric care as part of improving patient safety.
#
#
13 Monitoring after PPH
Consensus-based recommendation 13.E1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
After a PPH, individually adapted monitoring must be carried out. |
#
14 Documentation
Consensus-based recommendation 14.E1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Careful documentation of every event defined as an emergency is essential. The use of special forms developed for the respective organisational unit is recommended. |
#
15 Debriefing
Consensus-based recommendation 15.E1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
After PPH, the affected patient and her companion(s) must be offered a follow-up discussion using language comprehensible to non-medical specialists. The discussion must include a member of the obstetric team if necessary and be held in the first days postpartum. It should be documented for the patientʼs further outpatient care. The patient must be informed that the offer to have a discussion will hold good even after she has been discharged from hospital. |
Consensus-based statement 15.S1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Reference: [26] |
|
Interdisciplinary debriefing of the team is recommended. |
Consensus-based recommendation 15.E2 |
|
---|---|
Expert consensus |
Level of consensus +++ |
References: [26] |
|
A crisis intervention option should be available for the team; this applies particularly in cases where the outcome was fatal. |
#
16 Training
Consensus-based recommendation 16.E1 |
|
---|---|
Expert consensus |
Level of consensus +++ |
Structured simulations of peripartum haemorrhage and appropriate responses by an interdisciplinary team should be carried out regularly to improve the teamʼs technical und non-technical skills. |
#
#
#
Conflict of Interest/Interessenkonflikt
The conflicts of interest of all of the authors are listed in the long version of the guideline./Die Interessenkonflikte der Autorinnen und Autoren sind in der Langfassung der Leitlinie aufgelistet.
-
References/Literatur
- 1 Sheldon WR, Blum J, Vogel JP. et al. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014; 121 (Suppl. 01) 5-13
- 2 Reale SC, Easter SR, Xu X. et al. Trends in Postpartum Hemorrhage in the United States From 2010 to 2014. Anesth Analg 2020; 130: e119-e122
- 3 Greene RA, McKernan J, Manning E. et al. Major obstetric haemorrhage: Incidence, management and quality of care in Irish maternity units. Eur J Obstet Gynecol Reprod Biol 2021; 257: 114-120
- 4 Deneux-Tharaux C, Bonnet MP, Tort J. [Epidemiology of post-partum haemorrhage]. J Gynecol Obstet Biol Reprod (Paris) 2014; 43: 936-950
- 5 Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United States, 1994–2006. Am J Obstet Gynecol 2010; 202: 353.e1-353.e6
- 6 Kramer MS, Berg C, Abenhaim H. et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol 2013; 209: 449.e1-449.e7
- 7 Joseph KS, Rouleau J, Kramer MS. et al. Investigation of an increase in postpartum haemorrhage in Canada. BJOG 2007; 114: 751-759
- 8 Samangaya R, Pennington R, Vause S. Factors relating to a rising incidence of major postpartum haemorrhage. BJOG 2010; 117: 370 author reply 370–371
- 9 Kramer MS, Dahhou M, Vallerand D. et al. Risk Factors for Postpartum Hemorrhage: Can We Explain the Recent Temporal Increase?. J Obstet Gynaecol Can 2011; 33: 810-819
- 10 Buchanan SL, Patterson JA, Roberts CL. et al. Trends and morbidity associated with oxytocin use in labour in nulliparas at term. Aust N Z J Obstet Gynaecol 2012; 52: 173-178
- 11 Mehrabadi A, Hutcheon JA, Lee L. et al. Epidemiological investigation of a temporal increase in atonic postpartum haemorrhage: a population-based retrospective cohort study. BJOG 2013; 120: 853-862
- 12 Mousa HA, Walkinshaw S. Major postpartum haemorrhage. Curr Opin Obstet Gynecol 2001; 13: 595-603
- 13 AbouZahr C. Global burden of maternal death and disability. Br Med Bull 2003; 67: 1-11
- 14 Khan KS, Wojdyla D, Say L. et al. WHO analysis of causes of maternal death: a systematic review. Lancet 2006; 367: 1066-1074
- 15 Roberts CL, Ford JB, Algert CS. et al. Trends in adverse maternal outcomes during childbirth: a population-based study of severe maternal morbidity. BMC Pregnancy Childbirth 2009; 9: 7
- 16 Haeri S, Dildy 3rd GA. Maternal mortality from hemorrhage. Semin Perinatol 2012; 36: 48-55
- 17 Grobman WA, Bailit JL, Rice MM. et al. Frequency of and factors associated with severe maternal morbidity. Obstet Gynecol 2014; 123: 804-810
- 18 Cantwell R, Clutton-Brock T, Cooper G. et al. Saving Mothersʼ Lives: Reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011; 118 (Suppl. 01) 1-203
- 19 Bouvier-Colle MH, Saucedo M, Deneux-Tharaux C. CNEMM. [The confidential enquiries into maternal deaths, 1996–2006 in France: what consequences for the obstetrical care?]. J Gynecol Obstet Biol Reprod (Paris) 2011; 40: 87-102
- 20 Farquhar C, Sadler L, Masson V. et al. Beyond the numbers: classifying contributory factors and potentially avoidable maternal deaths in New Zealand, 2006–2009. Am J Obstet Gynecol 2011; 205: 331.e1-331.e8
- 21 Saucedo M, Deneux-Tharaux C, Bouvier-Colle MH. French National Experts Committee on Maternal Mortality. Ten years of confidential inquiries into maternal deaths in France, 1998–2007. Obstet Gynecol 2013; 122: 752-760
- 22 Duthie SJ, Ven D, Yung GLK. et al. Discrepancy between laboratory determination and visual estimation of blood loss during normal delivery. Eur J Obstet Gynecol Reprod Biol 1991; 38: 119-124
- 23 Descargues G, Pitette P, Gravier A. et al. [Missed diagnosis of postpartum hemorrhage]. J Gynecol Obstet Biol Reprod (Paris) 2001; 30: 590-600
- 24 Bose P, Regan F, Paterson-Brown S. Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG 2006; 113: 919-924
- 25 Rath W, Schneider M. Definitionen und Diagnostik postpartaler Blutungen (PPH): Unterschätzte Probleme!. Geburtshilfe Frauenheilkd 2010; 70: 36-40
- 26 Schlembach D, Annecke T, Girard T. et al. Peripartal haemorrhage, diagnosis and therapy. Guideline of the German Society of Gynaecology and Obstetrics (S2k-Level, AWMF Registry No. 015/063, June 2022). 2022 Accessed June 18, 2023 at: http://www.awmf.org/leitlinien/detail/ll/015-063.html
- 27 Bouwmeester FW, Bolte AC, van Geijn HP. Pharmacological and surgical therapy for primary postpartum hemorrhage. Curr Pharm Des 2005; 11: 759-773
- 28 Schlembach D, Mörtl MG. Postpartale Hämorrhagie – Von der Definition über die Klinik zur Diagnose. Speculum 2010; 28: 5-9
- 29 Borovac-Pinheiro A, Pacagnella RC, Cecatti JG. et al. Postpartum hemorrhage: new insights for definition and diagnosis. Am J Obstet Gynecol 2018; 219: 162-168
- 30 Drew T, Carvalho JCA, Subramanian C. et al. The association of shock index and haemoglobin variation with postpartum haemorrhage after vaginal delivery: a prospective cohort pilot study. Int J Obstet Anesth 2021; 45: 67-73
- 31 Merz E, Eichhorn KH, von Kaisenberg C. et al. Arbeitsgruppe der DEGUM-Stufe III. [Updated quality requirements regarding secondary differentiated ultrasound examination in prenatal diagnostics (= DEGUM level II) in the period from 18 + 0 to 21 + 6 weeks of gestation]. Ultraschall Med 2012; 33: 593-596
- 32 Main EK, Goffman D, Scavone BM. et al. National Partnership for Maternal Safety. Obstet Gynecol 2015; 126: 155-162
- 33 Dupont C, Touzet S, Colin C. et al. Incidence and management of postpartum haemorrhage following the dissemination of guidelines in a network of 16 maternity units in France. Int J Obstet Anesth 2009; 18: 320-327
- 34 Mavrides E, Allard S, Chandraharan E. et al. Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52. BJOG 2017; 124: e106-e149
- 35 Upadhyay K, Scholefield H. Risk management and medicolegal issues related to postpartum haemorrhage. Best Pract Res Clin Obstet Gynaecol 2008; 22: 1149-1169
- 36 Driessen M, Bouvier-Colle MH, Dupont C. et al. Postpartum hemorrhage resulting from uterine atony after vaginal delivery: factors associated with severity. Obstet Gynecol 2011; 117: 21-31
- 37 Abdul-Kadir R, McLintock C, Ducloy AS. et al. Evaluation and management of postpartum hemorrhage: consensus from an international expert panel. Transfusion 2014; 54: 1756-1768
- 38 Dupont C, Deneux-Tharaux C, Touzet S. et al. Clinical audit: a useful tool for reducing severe postpartum haemorrhages?. Int J Qual Health Care 2011; 23: 583-589
- 39 Shields LE, Smalarz K, Reffigee L. et al. Comprehensive maternal hemorrhage protocols improve patient safety and reduce utilization of blood products. Am J Obstet Gynecol 2011; 205: 368.e1-368.e8
- 40 Ananth CV, Smulian JC, Vintzileos AM. The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet Gynecol 1997; 177: 1071-1078
- 41 Getahun D, Oyelese Y, Salihu HM. et al. Previous cesarean delivery and risks of placenta previa and placental abruption. Obstet Gynecol 2006; 107: 771-778
- 42 Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol 2011; 205: 262.e1-262.e8
- 43 Klar M, Michels KB. Cesarean section and placental disorders in subsequent pregnancies–a meta-analysis. J Perinat Med 2014; 42: 571-583
- 44 Downes KL, Hinkle SN, Sjaarda LA. et al. Previous prelabor or intrapartum cesarean delivery and risk of placenta previa. Am J Obstet Gynecol 2015; 212: 669.e1-669.e6
- 45 Grady R, Alavi N, Vale R. et al. Elective single embryo transfer and perinatal outcomes: a systematic review and meta-analysis. Fertil Steril 2012; 97: 324-331
- 46 Korosec S, Ban Frangez H, Verdenik I. et al. Singleton pregnancy outcomes after in vitro fertilization with fresh or frozen-thawed embryo transfer and incidence of placenta praevia. Biomed Res Int 2014; 2014: 431797
- 47 Qin J, Liu X, Sheng X. et al. Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies. Fertil Steril 2016; 105: 73-85.e1–e6
- 48 Karami M, Jenabi E, Fereidooni B. The association of placenta previa and assisted reproductive techniques: a meta-analysis. J Matern Fetal Neonatal Med 2018; 31: 1940-1947
- 49 Comstock CH. Antenatal diagnosis of placenta accreta: a review. Ultrasound Obstet Gynecol 2005; 26: 89-96
- 50 Jauniaux E, Alfirevic Z, Bhide AG. et al. Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. BJOG 2019; 126: e1-e48
- 51 Reddy UM, Abuhamad AZ, Levine D. et al. Fetal Imaging Workshop Invited Participants. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. J Ultrasound Med 2014; 33: 745-757
- 52 Ghi T, Contro E, Martina T. et al. Cervical length and risk of antepartum bleeding in women with complete placenta previa. Ultrasound Obstet Gynecol 2009; 33: 209-212
- 53 Zaitoun MM, El Behery MM, Abd El Hameed AA. et al. Does cervical length and the lower placental edge thickness measurement correlates with clinical outcome in cases of complete placenta previa?. Arch Gynecol Obstet 2011; 284: 867-873
- 54 Mimura T, Hasegawa J, Nakamura M. et al. Correlation between the cervical length and the amount of bleeding during cesarean section in placenta previa. J Obstet Gynaecol Res 2011; 37: 830-835
- 55 Sekiguchi A, Nakai A, Okuda N. et al. Consecutive cervical length measurements as a predictor of preterm cesarean section in complete placenta previa. J Clin Ultrasound 2015; 43: 17-22
- 56 Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005; 192: 1458-1461
- 57 Thurn L, Lindqvist PG, Jakobsson M. et al. Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG 2016; 123: 1348-1355
- 58 Silver RM, Landon MB, Rouse DJ. et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107: 1226-1232
- 59 Rajan PV, Wing DA. Postpartum hemorrhage: evidence-based medical interventions for prevention and treatment. Clin Obstet Gynecol 2010; 53: 165-181
- 60 Bailit JL, Grobman WA, Rice MM. et al. Morbidly adherent placenta treatments and outcomes. Obstet Gynecol 2015; 125: 683-689
- 61 Bowman ZS, Eller AG, Kennedy AM. et al. Accuracy of ultrasound for the prediction of placenta accreta. Am J Obstet Gynecol 2014; 211: 177.e1-177.e7
- 62 Timor-Tritsch IE, Monteagudo A, Cali G. et al. Cesarean Scar Pregnancy: Diagnosis and Pathogenesis. Obstet Gynecol Clin North Am 2019; 46: 797-811
- 63 Singh D, Kaur L. When a cesarean section scar is more than an innocent bystander in a subsequent pregnancy: Ultrasound to the rescue. J Clin Ultrasound 2017; 45: 319-327
- 64 Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol 2017; 217: 27-36
- 65 Collins SL, Ashcroft A, Braun T. et al. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol 2016; 47: 271-275
- 66 Tremblay E, Therasse E, Thomassin-Naggara I. et al. Quality initiatives: guidelines for use of medical imaging during pregnancy and lactation. Radiographics 2012; 32: 897-911
- 67 Thomsen HS, Stacul F, Bellin M-F. et al. ESUR Guidelines on Contrast Agents. European Society of Urogenital Radiology; 2018. Accessed June 18, 2023 at: https://www.esur.org/esur-guidelines-on-contrast-agents/
- 68 Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and Lactation. Obstet Gynecol 2017; 130: e210-e216
- 69 Chen S, Pang D, Li Y. et al. Serum miRNA biomarker discovery for placenta accreta spectrum. Placenta 2020; 101: 215-220
- 70 Jauniaux E, Bhide A, Kennedy A. et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Prenatal diagnosis and screening. Int J Gynaecol Obstet 2018; 140: 274-280
- 71 Leduc D, Senikas V, Lalonde AB. No. 235-Active Management of the Third Stage of Labour: Prevention and Treatment of Postpartum Hemorrhage. J Obstet Gynaecol Can 2018; 40: e841-e855
- 72 Rath W. [Active management of the third stage of labour (AMTSL) – the end of a 50 years-dogma?]. Z Geburtshilfe Neonatol 2013; 217: 173-176
- 73 Sheldon WR, Durocher J, Winikoff B. et al. How effective are the components of active management of the third stage of labor?. BMC Pregnancy Childbirth 2013; 13: 46
- 74 Begley CM, Gyte GM, Devane D. et al. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev 2015; (03) CD007412
- 75 Gizzo S, Patrelli TS, Gangi SD. et al. Which uterotonic is better to prevent the postpartum hemorrhage? Latest news in terms of clinical efficacy, side effects, and contraindications: a systematic review. Reprod Sci 2013; 20: 1011-1019
- 76 Westhoff G, Cotter AM, Tolosa JE. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. Cochrane Database Syst Rev 2013; (10) CD001808
- 77 Weeks A. The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next?. BJOG 2015; 122: 202-210
- 78 Moertl MG, Friedrich S, Kraschl J. et al. Haemodynamic effects of carbetocin and oxytocin given as intravenous bolus on women undergoing caesarean delivery: a randomised trial. BJOG 2011; 118: 1349-1356
- 79 van der Nelson H, OʼBrien S, Burnard S. et al. Intramuscular oxytocin versus Syntometrine((R)) versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: a randomised double-blinded clinical trial of effectiveness, side effects and quality of life. BJOG 2021; 128: 1236-1246
- 80 Drugs and Lactation Database (LactMed) [Internet] – Ergonovine. Bethesda (MD): National Library of Medicine (US); 2006. Accessed June 18, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK501332/ [Updated 2018 Oct 31]
- 81 Sentilhes L, Daniel V, Deneux-Tharaux C. TRAAP2 Study Group and the Groupe de Recherche en Obstétrique et Gynécologie (GROG). TRAAP2 – TRAnexamic Acid for Preventing postpartum hemorrhage after cesarean delivery: a multicenter randomized, doubleblind, placebo- controlled trial – a study protocol. BMC Pregnancy Childbirth 2020; 20: 63
- 82 Sentilhes L, Winer N, Azria E. et al. Tranexamic Acid for the Prevention of Blood Loss after Vaginal Delivery. N Engl J Med 2018; 379: 731-742
- 83 Morales M, Ceysens G, Jastrow N. et al. Spontaneous delivery or manual removal of the placenta during caesarean section: a randomised controlled trial. BJOG 2004; 111: 908-912
- 84 Anorlu RI, Maholwana B, Hofmeyr GJ. Methods of delivering the placenta at caesarean section. Cochrane Database Syst Rev 2008; (03) CD004737
- 85 Phung LC, Farrington EK, Connolly M. et al. Intravenous oxytocin dosing regimens for postpartum hemorrhage prevention following cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 225: 250.e1-250.e38
- 86 Rath W. [Postpartum Haemorrhage (PPH): “too little is done too late”!]. Z Geburtshilfe Neonatol 2011; 215: 177-181
- 87 Meiser A, Casagranda O, Skipka G. et al. [Quantification of blood loss. How precise is visual estimation and what does its accuracy depend on?]. Anaesthesist 2001; 50: 13-20
- 88 Larsson C, Saltvedt S, Wiklund I. et al. Estimation of blood loss after cesarean section and vaginal delivery has low validity with a tendency to exaggeration. Acta Obstet Gynecol Scand 2006; 85: 1448-1452
- 89 Toledo P, McCarthy RJ, Hewlett BJ. et al. The accuracy of blood loss estimation after simulated vaginal delivery. Anesth Analg 2007; 105: 1736-1740 table of contents
- 90 von Heymann C, Kaufner L, Korber M. [Perioperative management and therapy of bleeding complications]. Anasthesiol Intensivmed Notfallmed Schmerzther 2014; 49: 196-204 quiz 205
- 91 Kozek-Langenecker SA, Ahmed AB, Afshari A. et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016. Eur J Anaesthesiol 2017; 34: 332-395
- 92 Parry Smith WR, Papadopoulou A, Thomas E. et al. Uterotonic agents for first-line treatment of postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev 2020; (11) CD012754
- 93 Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol 2017; 130: e168-e186
- 94 Bienstock JL, Eke AC, Hueppchen NA. Postpartum Hemorrhage. N Engl J Med 2021; 384: 1635-1645
- 95 Leng G, Sabatier N. Measuring Oxytocin and Vasopressin: Bioassays, Immunoassays and Random Numbers. J Neuroendocrinol 2016; 28 DOI: 10.1111/jne.12413.
- 96 Schmitz T, Tararbit K, Dupont C. et al. Prostaglandin E2 analogue sulprostone for treatment of atonic postpartum hemorrhage. Obstet Gynecol 2011; 118 (2 Pt 1): 257-265
- 97 Langer B, Boudier E, Haberstich R. et al. Collège National des Gynécologues et Obstétriciens Français; Agence Nationale dʼAccréditation et dʼEvaluation en Santé. [Obstetrical management in the event of persistent or worsening postpartum hemorrhage despite initial measures]. J Gynecol Obstet Biol Reprod (Paris) 2004; 33 (8 Suppl.): 4S73-4S79
- 98 Hösli I, Büchel J. Stellenwert von Kontraktionsmitteln bei der postpartalen Hämorrhagie. Gynäkologe 2019; 52: 408-415
- 99 Munoz M, Stensballe J, Ducloy-Bouthors AS. et al. Patient blood management in obstetrics: prevention and treatment of postpartum haemorrhage. A NATA consensus statement. Blood Transfus 2019; 17: 112-136
- 100 Della Corte L, Saccone G, Locci M. et al. Tranexamic acid for treatment of primary postpartum hemorrhage after vaginal delivery: a systematic review and meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 2020; 33: 869-874
- 101 Shakur H, Roberts I, Fawole B. et al. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 389: 2105-2116
- 102 Gayet-Ageron A, Prieto-Merino D, Ker K. et al. Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients. Lancet 2018; 391: 125-132
- 103 Chan LL, Lo TK, Lau WL. et al. Use of second-line therapies for management of massive primary postpartum hemorrhage. Int J Gynaecol Obstet 2013; 122: 238-243
- 104 Ibrahim M, Ziegler C, Klam SL. et al. Incidence, indications, and predictors of adverse outcomes of postpartum hysterectomies: 20-year experience in a tertiary care centre. J Obstet Gynaecol Can 2014; 36: 14-20
- 105 Fox KA, Berghella V, Chakrabarti A. Postpartum hemorrhage: Use of intrauterine tamponade to control bleeding [updated September 26, 2022]. Accessed June 18, 2023 at: https://www.uptodate.com
- 106 Gronvall M, Tikkanen M, Tallberg E. et al. Use of Bakri balloon tamponade in the treatment of postpartum hemorrhage: a series of 50 cases from a tertiary teaching hospital. Acta Obstet Gynecol Scand 2013; 92: 433-438
- 107 Maier RC. Control of postpartum hemorrhage with uterine packing. Am J Obstet Gynecol 1993; 169 (2 Pt 1): 317-321 discussion 321 -323
- 108 Dabelea V, Schultze PM, McDuffie jr. RS. Intrauterine balloon tamponade in the management of postpartum hemorrhage. Am J Perinatol 2007; 24: 359-364
- 109 Patacchiola F, DʼAlfonso A, Di Fonso A. et al. Intrauterine balloon tamponade as management of postpartum haemorrhage and prevention of haemorrhage related to low-lying placenta. Clin Exp Obstet Gynecol 2012; 39: 498-499
- 110 Aibar L, Aguilar MT, Puertas A. et al. Bakri balloon for the management of postpartum hemorrhage. Acta Obstet Gynecol Scand 2013; 92: 465-467
- 111 Florian A, Carles G, Dallah F. et al. [Value of the Linton-Nachlas balloon for the management of post-partum hemorrhage: a series of 25 cases]. J Gynecol Obstet Biol Reprod (Paris) 2013; 42: 493-498
- 112 Nelson BD, Stoklosa H, Ahn R. et al. Use of uterine balloon tamponade for control of postpartum hemorrhage by community-based health providers in South Sudan. Int J Gynaecol Obstet 2013; 122: 27-32
- 113 Tindell K, Garfinkel R, Abu-Haydar E. et al. Uterine balloon tamponade for the treatment of postpartum haemorrhage in resource-poor settings: a systematic review. BJOG 2013; 120: 5-14
- 114 Morel O, Perdriolle-Galet E, Mezan de Malartic C. et al. [Management of severe or persistent postpartum hemorrhage after vaginal delivery]. J Gynecol Obstet Biol Reprod (Paris) 2014; 43: 1019-1029
- 115 Rodriguez MI, Bullard M, Jensen JT. et al. Management of Postpartum Hemorrhage With a Mini-Sponge Tamponade Device. Obstet Gynecol 2020; 136: 876-881
- 116 Schmid BC, Rezniczek GA, Rolf N. et al. Uterine packing with chitosan-covered gauze for control of postpartum hemorrhage. Am J Obstet Gynecol 2013; 209: 225.e1-225.e5
- 117 Carles G, Dabiri C, McHirgui A. et al. Uses of chitosan for treating different forms of serious obstetrics hemorrhages. J Gynecol Obstet Hum Reprod 2017; 46: 693-695
- 118 Dueckelmann AM, Hinkson L, Nonnenmacher A. et al. Uterine packing with chitosan-covered gauze compared to balloon tamponade for managing postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol 2019; 240: 151-155
- 119 Al-Harbi NA, Al-Abra ES, Alabbad NS. Utero-vaginal packing. Seven years review in the management of post partum hemorrhage due to placenta previa/accreta at a maternity hospital in Central Saudi Arabia. Saudi Med J 2009; 30: 243-246
- 120 Samartha Ram H, Shankar Ram HS, Panicker V. et al. Vacuum retraction of uterus for the management of atonic postpartum hemorrhage. IOSR J Dent Med Sci (IOSR-JDMS) 2014; 13: 15-19
- 121 Marasinghe JP. Control of Postpartum Hemorrhage Using Vacuum-Induced Uterine Tamponade. Obstet Gynecol 2016; 128: 910
- 122 Purwosunu Y, Sarkoen W, Arulkumaran S. et al. Control of Postpartum Hemorrhage Using Vacuum-Induced Uterine Tamponade. Obstet Gynecol 2016; 128: 33-36
- 123 Sentilhes L, Brun S, Madar H. et al. Control of Postpartum Hemorrhage Using Vacuum-Induced Uterine Tamponade. Obstet Gynecol 2016; 128: 909-910
- 124 DʼAlton ME, Rood KM, Smid MC. et al. Intrauterine Vacuum-Induced Hemorrhage-Control Device for Rapid Treatment of Postpartum Hemorrhage. Obstet Gynecol 2020; 136: 882-891
- 125 Hofmeyr GJ, Singata-Madliki M. Novel suction tube uterine tamponade for treating intractable postpartum haemorrhage: description of technique and report of three cases. BJOG 2020; 127: 1280-1283
- 126 Haslinger C, Weber K, Zimmermann R. Vacuum-Induced Tamponade for Treatment of Postpartum Hemorrhage. Obstet Gynecol 2021; 138: 361-365
- 127 Diemert A, Ortmeyer G, Hollwitz B. et al. The combination of intrauterine balloon tamponade and the B-Lynch procedure for the treatment of severe postpartum hemorrhage. Am J Obstet Gynecol 2012; 206: 65.e1-65.e4
- 128 Yoong W, Ridout A, Memtsa M. et al. Application of uterine compression suture in association with intrauterine balloon tamponade (‘uterine sandwich’) for postpartum hemorrhage. Acta Obstet Gynecol Scand 2012; 91: 147-151
- 129 Dhillon AS, Dhillon K. Use of combination method (uterine sandwich technique) to control postpartum hemorrhage. Int J Reprod Contracept Obstet Gynecol 2018; 7: 2753-2758
- 130 Seidel V, Braun T, Weizsacker K. et al. Application of chitosan-covered gauze in combination with intrauterine balloon tamponade for postpartum hemorrhage treatment – Case report of a novel “uterine sandwich” approach. Int J Surg Case Rep 2018; 48: 101-103
- 131 Nelson WL, OʼBrien JM. The uterine sandwich for persistent uterine atony: combining the B-Lynch compression suture and an intrauterine Bakri balloon. Am J Obstet Gynecol 2007; 196: e9-e10
- 132 Merrick K, Jibodu OA, Rajesh U. The difficult PPH: experience of combined use of B-Lynch brace suture and intrauterine Bakri balloon in York hospital, UK. J Obstet Gynaecol 2013; 33: 314-315
- 133 Cekmez Y, Ozkaya E, Ocal FD. et al. Experience with different techniques for the management of postpartum hemorrhage due to uterine atony: compression sutures, artery ligation and Bakri balloon. Ir J Med Sci 2015; 184: 399-402
- 134 Schlembach D, Mörtl MG, Girard T. et al. Management der postpartalen Blutung. Der D-A-CH-Algorithmus. Frauenarzt 2013; 54: 1072-1080
- 135 Carvajal JA, Ramos I, Kusanovic JP. et al. Damage-control resuscitation in obstetrics. J Matern Fetal Neonatal Med 2022; 35: 785-798
- 136 Deux JF, Bazot M, Le Blanche AF. et al. Is selective embolization of uterine arteries a safe alternative to hysterectomy in patients with postpartum hemorrhage?. AJR Am J Roentgenol 2001; 177: 145-149
- 137 Rath W, Hackethal A, Bohlmann MK. Second-line treatment of postpartum haemorrhage (PPH). Arch Gynecol Obstet 2012; 286: 549-561
- 138 Keogh J, Tsokos N. Aortic compression in massive postpartum haemorrhage–an old but lifesaving technique. Aust N Z J Obstet Gynaecol 1997; 37: 237-238
- 139 Riley DP, Burgess RW. External abdominal aortic compression: a study of a resuscitation manoeuvre for postpartum haemorrhage. Anaesth Intensive Care 1994; 22: 571-575
- 140 Pacheco LD, Lozada MJ, Saade GR. et al. Damage-Control Surgery for Obstetric Hemorrhage. Obstet Gynecol 2018; 132: 423-427
- 141 Yoong W, Lavina A, Ali A. et al. Abdomino-pelvic packing revisited: An often forgotten technique for managing intractable venous obstetric haemorrhage. Aust N Z J Obstet Gynaecol 2019; 59: 201-207
- 142 Kainer F. Damage Control Surgery: Operative Behandlungskonzepte im Sinne einer „Life Saving Strategy“ – Uteruserhaltende Methoden im Gegensatz zur PP-Hysterektomie: Sind Organerhalt oder Reduktion von Morbidität und Mortalität ein Widerspruch?. Speculum 2010; 28: 22-24
- 143 Hollatz-Galuschki E, Michaelis S, Rauber S. et al. Uteruskompressionsnähte – Welche Nahttechnik ist wann indiziert?. Geburtshilfe Frauenheilkd 2013; 73: P70
- 144 AbdRabbo SA. Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus. Am J Obstet Gynecol 1994; 171: 694-700
- 145 Morel O, Malartic C, Muhlstein J. et al. Pelvic arterial ligations for severe post-partum hemorrhage. Indications and techniques. J Visc Surg 2011; 148: e95-e102
- 146 Ahonen J, Stefanovic V, Lassila R. Management of post-partum haemorrhage. Acta Anaesthesiol Scand 2010; 54: 1164-1178
- 147 Rossi AC, Lee RH, Chmait RH. Emergency postpartum hysterectomy for uncontrolled postpartum bleeding: a systematic review. Obstet Gynecol 2010; 115: 637-644
- 148 Schols SE, Feijge MA, Lance MD. et al. Effects of plasma dilution on tissue-factor-induced thrombin generation and thromboelastography: partly compensating role of platelets. Transfusion 2008; 48: 2384-2394
- 149 Tanaka KA, Key NS, Levy JH. Blood coagulation: hemostasis and thrombin regulation. Anesth Analg 2009; 108: 1433-1446
- 150 Lier H, Hofer S, Annecke T. Anästhesiologisches Management der peripartalen Hämorrhagie. Anasthesiol Intensivmed Notfallmed Schmerzther 2020; 55: 686-701
- 151 Gillissen A, van den Akker T, Caram-Deelder C. et al. Association between fluid management and dilutional coagulopathy in severe postpartum haemorrhage: a nationwide retrospective cohort study. BMC Pregnancy Childbirth 2018; 18: 398
- 152 Futier E, Robin E, Jabaudon M. et al. Central venous O2 saturation and venous-to-arterial CO2 difference as complementary tools for goal-directed therapy during high-risk surgery. Crit Care 2010; 14: R193
- 153 Karlsson O, Jeppsson A, Hellgren M. Major obstetric haemorrhage: monitoring with thromboelastography, laboratory analyses or both?. Int J Obstet Anesth 2014; 23: 10-17
- 154 Mellin-Olsen J, Staender S, Whitaker DK. et al. The Helsinki Declaration on Patient Safety in Anaesthesiology. Eur J Anaesthesiol 2010; 27: 592-597
- 155 Grottke O, Frietsch T, Maas M. et al. German Society of Anaesthesiology and Intensive Care Medicine. [Dealing with massive bleeding and associated perioperative coagulopathy: recommendations for action of the German Society of Anaesthesiology and Intensive Care Medicine]. Anaesthesist 2013; 62: 213-216 218–220, 222–224
- 156 Einerson BD, Miller ES, Grobman WA. Does a postpartum hemorrhage patient safety program result in sustained changes in management and outcomes?. Am J Obstet Gynecol 2015; 212: 140-144.e1
- 157 Haslinger C, Korte W, Hothorn T. et al. The impact of prepartum factor XIII activity on postpartum blood loss. J Thromb Haemost 2020; 18: 1310-1319
- 158 Listyo S, Forrest E, Graf L. et al. The Need for Red Cell Support During Non-Cardiac Surgery Is Associated to Pre-Transfusion Levels of FXIII and the Platelet Count. J Clin Med 2020; 9: 2456
- 159 Wissenschaftlicher Beirat der Bundesärztekammer, Arbeitskreis „Querschnitts-Leitlinien Hämotherapie“. Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten – Gesamtnovelle 2020. Bundesärztekammer, Hrsg. 2020; Accessed June 18, 2023 at: https://www.bundesaerztekammer.de/fileadmin/user_upload/_old-files/downloads/pdf-Ordner/MuE/Querschnitts-Leitlinien_BAEK_zur_Therapie_mit_Blutkomponenten_und_Plasmaderivaten-Gesamtnovelle_2020.pdf Dt Ärzteblatt 2020; 117: A1883/B1603
- 160 Collins PW, Cannings-John R, Bruynseels D. et al. Viscoelastometric-guided early fibrinogen concentrate replacement during postpartum haemorrhage: OBS2, a double-blind randomized controlled trial. Br J Anaesth 2017; 119: 411-421
- 161 Collins PW, Lilley G, Bruynseels D. et al. Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study. Blood 2014; 124: 1727-1736
- 162 Collins PW, Bell SF, de Lloyd L. et al. Management of postpartum haemorrhage: from research into practice, a narrative review of the literature and the Cardiff experience. Int J Obstet Anesth 2019; 37: 106-117
- 163 Lier H, Rath W. Aktuelle interdisziplinäre Handlungsempfehlungen bei schweren peri-(post-)partalen Blutungen (PPH). Geburtshilfe Frauenheilkd 2011; 71: 577-588
- 164 Alfirevic Z, Elbourne D, Pavord S. et al. Use of recombinant activated factor VII in primary postpartum hemorrhage: the Northern European registry 2000–2004. Obstet Gynecol 2007; 110: 1270-1278
- 165 Barillari G, Frigo MG, Casarotto M. et al. Use of recombinant activated factor VII in severe post-partum haemorrhage: data from the Italian Registry: a multicentric observational retrospective study. Thromb Res 2009; 124: e41-e47
- 166 Phillips LE, McLintock C, Pollock W. et al. Recombinant activated factor VII in obstetric hemorrhage: experiences from the Australian and New Zealand Haemostasis Registry. Anesth Analg 2009; 109: 1908-1915
- 167 Huber AW, Raio L, Alberio L. et al. Recombinant human factor VIIa prevents hysterectomy in severe postpartum hemorrhage: single center study. J Perinat Med 2011; 40: 43-49
- 168 Lavigne-Lissalde G, Aya AG, Mercier FJ. et al. Recombinant human FVIIa for reducing the need for invasive second-line therapies in severe refractory postpartum hemorrhage: a multicenter, randomized, open controlled trial. J Thromb Haemost 2015; 13: 520-529
- 169 Colucci G, Helsing K, Biasiutti FD. et al. Standardized Management Protocol in Severe Postpartum Hemorrhage: A Single-Center Study. Clin Appl Thromb Hemost 2018; 24: 884-893
- 170 European Medicines Agency (EMA) – Committee for Medicinal Products for Human Use (CHMP). CHMP extension of indication variation assessment report: NovoSeven (Procedure No. EMEA/H/C/000074/II/0116). Accessed June 18, 2023 at: https://www.ema.europa.eu/en/documents/variation-report/novoseven-h-c-000074-ii-0116-epar-assessment-report-variation_en.pdf
- 171 Karanth L, Barua A, Kanagasabai S. et al. Desmopressin acetate (DDAVP) for preventing and treating acute bleeds during pregnancy in women with congenital bleeding disorders. Cochrane Database Syst Rev 2019; (02) CD009824
- 172 Trigg DE, Stergiotou I, Peitsidis P. et al. A systematic review: The use of desmopressin for treatment and prophylaxis of bleeding disorders in pregnancy. Haemophilia 2012; 18: 25-33
- 173 Kevane B, Donnelly J, DʼAlton M. et al. Risk factors for pregnancy-associated venous thromboembolism: a review. J Perinat Med 2014; 42: 417-425
- 174 Szecsi PB, Jorgensen M, Klajnbard A. et al. Haemostatic reference intervals in pregnancy. Thromb Haemost 2010; 103: 718-727
- 175 Karlsson O, Sporrong T, Hillarp A. et al. Prospective longitudinal study of thromboelastography and standard hemostatic laboratory tests in healthy women during normal pregnancy. Anesth Analg 2012; 115: 890-898
- 176 James AH, Konkle BA, Bauer KA. Prevention and treatment of venous thromboembolism in pregnancy in patients with hereditary antithrombin deficiency. Int J Womens Health 2013; 5: 233-241
- 177 Gallos G, Redai I, Smiley RM. The role of the anesthesiologist in management of obstetric hemorrhage. Semin Perinatol 2009; 33: 116-123
- 178 Kuczkowski KM. Anesthesia for the repeat cesarean section in the parturient with abnormal placentation: what does an obstetrician need to know?. Arch Gynecol Obstet 2006; 273: 319-321
- 179 Fuller AJ, Bucklin BA. Blood product replacement for postpartum hemorrhage. Clin Obstet Gynecol 2010; 53: 196-208
- 180 Bonnet MP, Deneux-Tharaux C, Bouvier-Colle MH. Critical care and transfusion management in maternal deaths from postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol 2011; 158: 183-188
- 181 Breymann C, Honegger C, Hösli I. et al. Diagnostik und Therapie der Eisenmangelanämie in der Schwangerschaft und postpartal. Expertenbrief Nr. 48 der Gynécologie Suisse SGGG (Kommission Qualitätssicherung). Gynäkologie 2017; 2: 31-34
- 182 Liu Y, Li X, Che X. et al. Intraoperative cell salvage for obstetrics: a prospective randomized controlled clinical trial. BMC Pregnancy Childbirth 2020; 20: 452
- 183 Khan KS, Moore P, Wilson M. et al. A randomised controlled trial and economic evaluation of intraoperative cell salvage during caesarean section in women at risk of haemorrhage: the SALVO (cell SALVage in Obstetrics) trial. Health Technol Assess 2018; 22: 1-88
- 184 Sullivan IJ, Ralph CJ. Obstetric intra-operative cell salvage: a review of an established cell salvage service with 1170 re-infused cases. Anaesthesia 2019; 74: 976-983
- 185 Catling S, Haynes SL. Coagulopathy during intraoperative cell salvage in a patient with major obstetric haemorrhage. Br J Anaesth 2011; 106: 749 author reply 750
- 186 Waldron S. Hypotension associated with leucocyte depletion filters following cell salvage in obstetrics. Anaesthesia 2011; 66: 133-134
- 187 de Lange NM, van Rheenen-Flach LE, Lance MD. et al. Peri-partum reference ranges for ROTEM(R) thromboelastometry. Br J Anaesth 2014; 112: 852-859
- 188 Agarwal S, Laycock HC. The debate ROTEMs on – the utility of point-of-care testing and fibrinogen concentrate in postpartum haemorrhage. Anaesthesia 2020; 75: 1247-1251
- 189 Wikkelso AJ, Edwards HM, Afshari A. et al. Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial. Br J Anaesth 2015; 114: 623-633
- 190 Allen L, Jauniaux E, Hobson S. et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management. Int J Gynaecol Obstet 2018; 140: 281-290
- 191 Sentilhes L, Kayem G, Chandraharan E. et al. FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management. Int J Gynaecol Obstet 2018; 140: 291-298
- 192 Collins SL, Alemdar B, van Beekhuizen HJ. et al. Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol 2019; 220: 511-526
- 193 Teixidor Vinas M, Chandraharan E, Moneta MV. et al. The role of interventional radiology in reducing haemorrhage and hysterectomy following caesarean section for morbidly adherent placenta. Clin Radiol 2014; 69: e345-e351
- 194 Teixidor Vinas M, Belli AM, Arulkumaran S. et al. Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after introduction of the Triple-P procedure. Ultrasound Obstet Gynecol 2015; 46: 350-355
- 195 Hsieh TT, Lee JD. Sonographic findings in acute puerperal uterine inversion. J Clin Ultrasound 1991; 19: 306-309
- 196 Pauleta JR, Rodrigues R, Melo MA. et al. Ultrasonographic diagnosis of incomplete uterine inversion. Ultrasound Obstet Gynecol 2010; 36: 260-261
- 197 Beringer RM, Patteril M. Puerperal uterine inversion and shock. Br J Anaesth 2004; 92: 439-441
- 198 You WB, Zahn CM. Postpartum hemorrhage: abnormally adherent placenta, uterine inversion, and puerperal hematomas. Clin Obstet Gynecol 2006; 49: 184-197
- 199 Witteveen T, van Stralen G, Zwart J. et al. Puerperal uterine inversion in the Netherlands: a nationwide cohort study. Acta Obstet Gynecol Scand 2013; 92: 334-337
- 200 Wilson AK, Martel MJ, Arsenault MY. et al. Maternal transport policy. J Obstet Gynaecol Can 2005; 27: 956-963
- 201 Wallwiener D, Beckmann MW. 219. Stellungnahme. Stellungnahme zur Frage der postoperativen Überwachung von Kaiserschnittpatientinnen. Geburtshilfe Frauenheilkd 2015; 75: 1216-1218
- 202 Gude P, Weber T. Geburtshilfliche Anästhesie und postoperative Überwachung. Practice Guidelines for Obstetric Anesthesia (ASA Task Force und SOAP) und Stellungnahme der DGAI/BDA zur postoperativen Überwachung nach Sectio. Anasthesiol Intensivmed Notfallmed Schmerzther 2018; 53: 696-702
- 203 Artyomenko VV, Nosenko VM. Anaesthesiologistsʼ simulation training during emergencies in obstetrics. Rom J Anaesth Intensive Care 2017; 24: 37-40
- 204 Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. Hum Resour Health 2020; 18: 2
- 205 Armenia S, Thangamathesvaran L, Caine AD. et al. The Role of High-Fidelity Team-Based Simulation in Acute Care Settings: A Systematic Review. Surg J (N Y) 2018; 4: e136-e151
Correspondence/Korrespondenzadresse
Publication History
Received: 06 April 2023
Accepted: 09 April 2023
Article published online:
28 June 2023
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References/Literatur
- 1 Sheldon WR, Blum J, Vogel JP. et al. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014; 121 (Suppl. 01) 5-13
- 2 Reale SC, Easter SR, Xu X. et al. Trends in Postpartum Hemorrhage in the United States From 2010 to 2014. Anesth Analg 2020; 130: e119-e122
- 3 Greene RA, McKernan J, Manning E. et al. Major obstetric haemorrhage: Incidence, management and quality of care in Irish maternity units. Eur J Obstet Gynecol Reprod Biol 2021; 257: 114-120
- 4 Deneux-Tharaux C, Bonnet MP, Tort J. [Epidemiology of post-partum haemorrhage]. J Gynecol Obstet Biol Reprod (Paris) 2014; 43: 936-950
- 5 Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United States, 1994–2006. Am J Obstet Gynecol 2010; 202: 353.e1-353.e6
- 6 Kramer MS, Berg C, Abenhaim H. et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol 2013; 209: 449.e1-449.e7
- 7 Joseph KS, Rouleau J, Kramer MS. et al. Investigation of an increase in postpartum haemorrhage in Canada. BJOG 2007; 114: 751-759
- 8 Samangaya R, Pennington R, Vause S. Factors relating to a rising incidence of major postpartum haemorrhage. BJOG 2010; 117: 370 author reply 370–371
- 9 Kramer MS, Dahhou M, Vallerand D. et al. Risk Factors for Postpartum Hemorrhage: Can We Explain the Recent Temporal Increase?. J Obstet Gynaecol Can 2011; 33: 810-819
- 10 Buchanan SL, Patterson JA, Roberts CL. et al. Trends and morbidity associated with oxytocin use in labour in nulliparas at term. Aust N Z J Obstet Gynaecol 2012; 52: 173-178
- 11 Mehrabadi A, Hutcheon JA, Lee L. et al. Epidemiological investigation of a temporal increase in atonic postpartum haemorrhage: a population-based retrospective cohort study. BJOG 2013; 120: 853-862
- 12 Mousa HA, Walkinshaw S. Major postpartum haemorrhage. Curr Opin Obstet Gynecol 2001; 13: 595-603
- 13 AbouZahr C. Global burden of maternal death and disability. Br Med Bull 2003; 67: 1-11
- 14 Khan KS, Wojdyla D, Say L. et al. WHO analysis of causes of maternal death: a systematic review. Lancet 2006; 367: 1066-1074
- 15 Roberts CL, Ford JB, Algert CS. et al. Trends in adverse maternal outcomes during childbirth: a population-based study of severe maternal morbidity. BMC Pregnancy Childbirth 2009; 9: 7
- 16 Haeri S, Dildy 3rd GA. Maternal mortality from hemorrhage. Semin Perinatol 2012; 36: 48-55
- 17 Grobman WA, Bailit JL, Rice MM. et al. Frequency of and factors associated with severe maternal morbidity. Obstet Gynecol 2014; 123: 804-810
- 18 Cantwell R, Clutton-Brock T, Cooper G. et al. Saving Mothersʼ Lives: Reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011; 118 (Suppl. 01) 1-203
- 19 Bouvier-Colle MH, Saucedo M, Deneux-Tharaux C. CNEMM. [The confidential enquiries into maternal deaths, 1996–2006 in France: what consequences for the obstetrical care?]. J Gynecol Obstet Biol Reprod (Paris) 2011; 40: 87-102
- 20 Farquhar C, Sadler L, Masson V. et al. Beyond the numbers: classifying contributory factors and potentially avoidable maternal deaths in New Zealand, 2006–2009. Am J Obstet Gynecol 2011; 205: 331.e1-331.e8
- 21 Saucedo M, Deneux-Tharaux C, Bouvier-Colle MH. French National Experts Committee on Maternal Mortality. Ten years of confidential inquiries into maternal deaths in France, 1998–2007. Obstet Gynecol 2013; 122: 752-760
- 22 Duthie SJ, Ven D, Yung GLK. et al. Discrepancy between laboratory determination and visual estimation of blood loss during normal delivery. Eur J Obstet Gynecol Reprod Biol 1991; 38: 119-124
- 23 Descargues G, Pitette P, Gravier A. et al. [Missed diagnosis of postpartum hemorrhage]. J Gynecol Obstet Biol Reprod (Paris) 2001; 30: 590-600
- 24 Bose P, Regan F, Paterson-Brown S. Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG 2006; 113: 919-924
- 25 Rath W, Schneider M. Definitionen und Diagnostik postpartaler Blutungen (PPH): Unterschätzte Probleme!. Geburtshilfe Frauenheilkd 2010; 70: 36-40
- 26 Schlembach D, Annecke T, Girard T. et al. Peripartal haemorrhage, diagnosis and therapy. Guideline of the German Society of Gynaecology and Obstetrics (S2k-Level, AWMF Registry No. 015/063, June 2022). 2022 Accessed June 18, 2023 at: http://www.awmf.org/leitlinien/detail/ll/015-063.html
- 27 Bouwmeester FW, Bolte AC, van Geijn HP. Pharmacological and surgical therapy for primary postpartum hemorrhage. Curr Pharm Des 2005; 11: 759-773
- 28 Schlembach D, Mörtl MG. Postpartale Hämorrhagie – Von der Definition über die Klinik zur Diagnose. Speculum 2010; 28: 5-9
- 29 Borovac-Pinheiro A, Pacagnella RC, Cecatti JG. et al. Postpartum hemorrhage: new insights for definition and diagnosis. Am J Obstet Gynecol 2018; 219: 162-168
- 30 Drew T, Carvalho JCA, Subramanian C. et al. The association of shock index and haemoglobin variation with postpartum haemorrhage after vaginal delivery: a prospective cohort pilot study. Int J Obstet Anesth 2021; 45: 67-73
- 31 Merz E, Eichhorn KH, von Kaisenberg C. et al. Arbeitsgruppe der DEGUM-Stufe III. [Updated quality requirements regarding secondary differentiated ultrasound examination in prenatal diagnostics (= DEGUM level II) in the period from 18 + 0 to 21 + 6 weeks of gestation]. Ultraschall Med 2012; 33: 593-596
- 32 Main EK, Goffman D, Scavone BM. et al. National Partnership for Maternal Safety. Obstet Gynecol 2015; 126: 155-162
- 33 Dupont C, Touzet S, Colin C. et al. Incidence and management of postpartum haemorrhage following the dissemination of guidelines in a network of 16 maternity units in France. Int J Obstet Anesth 2009; 18: 320-327
- 34 Mavrides E, Allard S, Chandraharan E. et al. Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52. BJOG 2017; 124: e106-e149
- 35 Upadhyay K, Scholefield H. Risk management and medicolegal issues related to postpartum haemorrhage. Best Pract Res Clin Obstet Gynaecol 2008; 22: 1149-1169
- 36 Driessen M, Bouvier-Colle MH, Dupont C. et al. Postpartum hemorrhage resulting from uterine atony after vaginal delivery: factors associated with severity. Obstet Gynecol 2011; 117: 21-31
- 37 Abdul-Kadir R, McLintock C, Ducloy AS. et al. Evaluation and management of postpartum hemorrhage: consensus from an international expert panel. Transfusion 2014; 54: 1756-1768
- 38 Dupont C, Deneux-Tharaux C, Touzet S. et al. Clinical audit: a useful tool for reducing severe postpartum haemorrhages?. Int J Qual Health Care 2011; 23: 583-589
- 39 Shields LE, Smalarz K, Reffigee L. et al. Comprehensive maternal hemorrhage protocols improve patient safety and reduce utilization of blood products. Am J Obstet Gynecol 2011; 205: 368.e1-368.e8
- 40 Ananth CV, Smulian JC, Vintzileos AM. The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet Gynecol 1997; 177: 1071-1078
- 41 Getahun D, Oyelese Y, Salihu HM. et al. Previous cesarean delivery and risks of placenta previa and placental abruption. Obstet Gynecol 2006; 107: 771-778
- 42 Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol 2011; 205: 262.e1-262.e8
- 43 Klar M, Michels KB. Cesarean section and placental disorders in subsequent pregnancies–a meta-analysis. J Perinat Med 2014; 42: 571-583
- 44 Downes KL, Hinkle SN, Sjaarda LA. et al. Previous prelabor or intrapartum cesarean delivery and risk of placenta previa. Am J Obstet Gynecol 2015; 212: 669.e1-669.e6
- 45 Grady R, Alavi N, Vale R. et al. Elective single embryo transfer and perinatal outcomes: a systematic review and meta-analysis. Fertil Steril 2012; 97: 324-331
- 46 Korosec S, Ban Frangez H, Verdenik I. et al. Singleton pregnancy outcomes after in vitro fertilization with fresh or frozen-thawed embryo transfer and incidence of placenta praevia. Biomed Res Int 2014; 2014: 431797
- 47 Qin J, Liu X, Sheng X. et al. Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies. Fertil Steril 2016; 105: 73-85.e1–e6
- 48 Karami M, Jenabi E, Fereidooni B. The association of placenta previa and assisted reproductive techniques: a meta-analysis. J Matern Fetal Neonatal Med 2018; 31: 1940-1947
- 49 Comstock CH. Antenatal diagnosis of placenta accreta: a review. Ultrasound Obstet Gynecol 2005; 26: 89-96
- 50 Jauniaux E, Alfirevic Z, Bhide AG. et al. Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. BJOG 2019; 126: e1-e48
- 51 Reddy UM, Abuhamad AZ, Levine D. et al. Fetal Imaging Workshop Invited Participants. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. J Ultrasound Med 2014; 33: 745-757
- 52 Ghi T, Contro E, Martina T. et al. Cervical length and risk of antepartum bleeding in women with complete placenta previa. Ultrasound Obstet Gynecol 2009; 33: 209-212
- 53 Zaitoun MM, El Behery MM, Abd El Hameed AA. et al. Does cervical length and the lower placental edge thickness measurement correlates with clinical outcome in cases of complete placenta previa?. Arch Gynecol Obstet 2011; 284: 867-873
- 54 Mimura T, Hasegawa J, Nakamura M. et al. Correlation between the cervical length and the amount of bleeding during cesarean section in placenta previa. J Obstet Gynaecol Res 2011; 37: 830-835
- 55 Sekiguchi A, Nakai A, Okuda N. et al. Consecutive cervical length measurements as a predictor of preterm cesarean section in complete placenta previa. J Clin Ultrasound 2015; 43: 17-22
- 56 Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005; 192: 1458-1461
- 57 Thurn L, Lindqvist PG, Jakobsson M. et al. Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG 2016; 123: 1348-1355
- 58 Silver RM, Landon MB, Rouse DJ. et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107: 1226-1232
- 59 Rajan PV, Wing DA. Postpartum hemorrhage: evidence-based medical interventions for prevention and treatment. Clin Obstet Gynecol 2010; 53: 165-181
- 60 Bailit JL, Grobman WA, Rice MM. et al. Morbidly adherent placenta treatments and outcomes. Obstet Gynecol 2015; 125: 683-689
- 61 Bowman ZS, Eller AG, Kennedy AM. et al. Accuracy of ultrasound for the prediction of placenta accreta. Am J Obstet Gynecol 2014; 211: 177.e1-177.e7
- 62 Timor-Tritsch IE, Monteagudo A, Cali G. et al. Cesarean Scar Pregnancy: Diagnosis and Pathogenesis. Obstet Gynecol Clin North Am 2019; 46: 797-811
- 63 Singh D, Kaur L. When a cesarean section scar is more than an innocent bystander in a subsequent pregnancy: Ultrasound to the rescue. J Clin Ultrasound 2017; 45: 319-327
- 64 Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol 2017; 217: 27-36
- 65 Collins SL, Ashcroft A, Braun T. et al. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol 2016; 47: 271-275
- 66 Tremblay E, Therasse E, Thomassin-Naggara I. et al. Quality initiatives: guidelines for use of medical imaging during pregnancy and lactation. Radiographics 2012; 32: 897-911
- 67 Thomsen HS, Stacul F, Bellin M-F. et al. ESUR Guidelines on Contrast Agents. European Society of Urogenital Radiology; 2018. Accessed June 18, 2023 at: https://www.esur.org/esur-guidelines-on-contrast-agents/
- 68 Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and Lactation. Obstet Gynecol 2017; 130: e210-e216
- 69 Chen S, Pang D, Li Y. et al. Serum miRNA biomarker discovery for placenta accreta spectrum. Placenta 2020; 101: 215-220
- 70 Jauniaux E, Bhide A, Kennedy A. et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Prenatal diagnosis and screening. Int J Gynaecol Obstet 2018; 140: 274-280
- 71 Leduc D, Senikas V, Lalonde AB. No. 235-Active Management of the Third Stage of Labour: Prevention and Treatment of Postpartum Hemorrhage. J Obstet Gynaecol Can 2018; 40: e841-e855
- 72 Rath W. [Active management of the third stage of labour (AMTSL) – the end of a 50 years-dogma?]. Z Geburtshilfe Neonatol 2013; 217: 173-176
- 73 Sheldon WR, Durocher J, Winikoff B. et al. How effective are the components of active management of the third stage of labor?. BMC Pregnancy Childbirth 2013; 13: 46
- 74 Begley CM, Gyte GM, Devane D. et al. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev 2015; (03) CD007412
- 75 Gizzo S, Patrelli TS, Gangi SD. et al. Which uterotonic is better to prevent the postpartum hemorrhage? Latest news in terms of clinical efficacy, side effects, and contraindications: a systematic review. Reprod Sci 2013; 20: 1011-1019
- 76 Westhoff G, Cotter AM, Tolosa JE. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. Cochrane Database Syst Rev 2013; (10) CD001808
- 77 Weeks A. The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next?. BJOG 2015; 122: 202-210
- 78 Moertl MG, Friedrich S, Kraschl J. et al. Haemodynamic effects of carbetocin and oxytocin given as intravenous bolus on women undergoing caesarean delivery: a randomised trial. BJOG 2011; 118: 1349-1356
- 79 van der Nelson H, OʼBrien S, Burnard S. et al. Intramuscular oxytocin versus Syntometrine((R)) versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: a randomised double-blinded clinical trial of effectiveness, side effects and quality of life. BJOG 2021; 128: 1236-1246
- 80 Drugs and Lactation Database (LactMed) [Internet] – Ergonovine. Bethesda (MD): National Library of Medicine (US); 2006. Accessed June 18, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK501332/ [Updated 2018 Oct 31]
- 81 Sentilhes L, Daniel V, Deneux-Tharaux C. TRAAP2 Study Group and the Groupe de Recherche en Obstétrique et Gynécologie (GROG). TRAAP2 – TRAnexamic Acid for Preventing postpartum hemorrhage after cesarean delivery: a multicenter randomized, doubleblind, placebo- controlled trial – a study protocol. BMC Pregnancy Childbirth 2020; 20: 63
- 82 Sentilhes L, Winer N, Azria E. et al. Tranexamic Acid for the Prevention of Blood Loss after Vaginal Delivery. N Engl J Med 2018; 379: 731-742
- 83 Morales M, Ceysens G, Jastrow N. et al. Spontaneous delivery or manual removal of the placenta during caesarean section: a randomised controlled trial. BJOG 2004; 111: 908-912
- 84 Anorlu RI, Maholwana B, Hofmeyr GJ. Methods of delivering the placenta at caesarean section. Cochrane Database Syst Rev 2008; (03) CD004737
- 85 Phung LC, Farrington EK, Connolly M. et al. Intravenous oxytocin dosing regimens for postpartum hemorrhage prevention following cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 225: 250.e1-250.e38
- 86 Rath W. [Postpartum Haemorrhage (PPH): “too little is done too late”!]. Z Geburtshilfe Neonatol 2011; 215: 177-181
- 87 Meiser A, Casagranda O, Skipka G. et al. [Quantification of blood loss. How precise is visual estimation and what does its accuracy depend on?]. Anaesthesist 2001; 50: 13-20
- 88 Larsson C, Saltvedt S, Wiklund I. et al. Estimation of blood loss after cesarean section and vaginal delivery has low validity with a tendency to exaggeration. Acta Obstet Gynecol Scand 2006; 85: 1448-1452
- 89 Toledo P, McCarthy RJ, Hewlett BJ. et al. The accuracy of blood loss estimation after simulated vaginal delivery. Anesth Analg 2007; 105: 1736-1740 table of contents
- 90 von Heymann C, Kaufner L, Korber M. [Perioperative management and therapy of bleeding complications]. Anasthesiol Intensivmed Notfallmed Schmerzther 2014; 49: 196-204 quiz 205
- 91 Kozek-Langenecker SA, Ahmed AB, Afshari A. et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016. Eur J Anaesthesiol 2017; 34: 332-395
- 92 Parry Smith WR, Papadopoulou A, Thomas E. et al. Uterotonic agents for first-line treatment of postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev 2020; (11) CD012754
- 93 Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol 2017; 130: e168-e186
- 94 Bienstock JL, Eke AC, Hueppchen NA. Postpartum Hemorrhage. N Engl J Med 2021; 384: 1635-1645
- 95 Leng G, Sabatier N. Measuring Oxytocin and Vasopressin: Bioassays, Immunoassays and Random Numbers. J Neuroendocrinol 2016; 28 DOI: 10.1111/jne.12413.
- 96 Schmitz T, Tararbit K, Dupont C. et al. Prostaglandin E2 analogue sulprostone for treatment of atonic postpartum hemorrhage. Obstet Gynecol 2011; 118 (2 Pt 1): 257-265
- 97 Langer B, Boudier E, Haberstich R. et al. Collège National des Gynécologues et Obstétriciens Français; Agence Nationale dʼAccréditation et dʼEvaluation en Santé. [Obstetrical management in the event of persistent or worsening postpartum hemorrhage despite initial measures]. J Gynecol Obstet Biol Reprod (Paris) 2004; 33 (8 Suppl.): 4S73-4S79
- 98 Hösli I, Büchel J. Stellenwert von Kontraktionsmitteln bei der postpartalen Hämorrhagie. Gynäkologe 2019; 52: 408-415
- 99 Munoz M, Stensballe J, Ducloy-Bouthors AS. et al. Patient blood management in obstetrics: prevention and treatment of postpartum haemorrhage. A NATA consensus statement. Blood Transfus 2019; 17: 112-136
- 100 Della Corte L, Saccone G, Locci M. et al. Tranexamic acid for treatment of primary postpartum hemorrhage after vaginal delivery: a systematic review and meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 2020; 33: 869-874
- 101 Shakur H, Roberts I, Fawole B. et al. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 389: 2105-2116
- 102 Gayet-Ageron A, Prieto-Merino D, Ker K. et al. Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients. Lancet 2018; 391: 125-132
- 103 Chan LL, Lo TK, Lau WL. et al. Use of second-line therapies for management of massive primary postpartum hemorrhage. Int J Gynaecol Obstet 2013; 122: 238-243
- 104 Ibrahim M, Ziegler C, Klam SL. et al. Incidence, indications, and predictors of adverse outcomes of postpartum hysterectomies: 20-year experience in a tertiary care centre. J Obstet Gynaecol Can 2014; 36: 14-20
- 105 Fox KA, Berghella V, Chakrabarti A. Postpartum hemorrhage: Use of intrauterine tamponade to control bleeding [updated September 26, 2022]. Accessed June 18, 2023 at: https://www.uptodate.com
- 106 Gronvall M, Tikkanen M, Tallberg E. et al. Use of Bakri balloon tamponade in the treatment of postpartum hemorrhage: a series of 50 cases from a tertiary teaching hospital. Acta Obstet Gynecol Scand 2013; 92: 433-438
- 107 Maier RC. Control of postpartum hemorrhage with uterine packing. Am J Obstet Gynecol 1993; 169 (2 Pt 1): 317-321 discussion 321 -323
- 108 Dabelea V, Schultze PM, McDuffie jr. RS. Intrauterine balloon tamponade in the management of postpartum hemorrhage. Am J Perinatol 2007; 24: 359-364
- 109 Patacchiola F, DʼAlfonso A, Di Fonso A. et al. Intrauterine balloon tamponade as management of postpartum haemorrhage and prevention of haemorrhage related to low-lying placenta. Clin Exp Obstet Gynecol 2012; 39: 498-499
- 110 Aibar L, Aguilar MT, Puertas A. et al. Bakri balloon for the management of postpartum hemorrhage. Acta Obstet Gynecol Scand 2013; 92: 465-467
- 111 Florian A, Carles G, Dallah F. et al. [Value of the Linton-Nachlas balloon for the management of post-partum hemorrhage: a series of 25 cases]. J Gynecol Obstet Biol Reprod (Paris) 2013; 42: 493-498
- 112 Nelson BD, Stoklosa H, Ahn R. et al. Use of uterine balloon tamponade for control of postpartum hemorrhage by community-based health providers in South Sudan. Int J Gynaecol Obstet 2013; 122: 27-32
- 113 Tindell K, Garfinkel R, Abu-Haydar E. et al. Uterine balloon tamponade for the treatment of postpartum haemorrhage in resource-poor settings: a systematic review. BJOG 2013; 120: 5-14
- 114 Morel O, Perdriolle-Galet E, Mezan de Malartic C. et al. [Management of severe or persistent postpartum hemorrhage after vaginal delivery]. J Gynecol Obstet Biol Reprod (Paris) 2014; 43: 1019-1029
- 115 Rodriguez MI, Bullard M, Jensen JT. et al. Management of Postpartum Hemorrhage With a Mini-Sponge Tamponade Device. Obstet Gynecol 2020; 136: 876-881
- 116 Schmid BC, Rezniczek GA, Rolf N. et al. Uterine packing with chitosan-covered gauze for control of postpartum hemorrhage. Am J Obstet Gynecol 2013; 209: 225.e1-225.e5
- 117 Carles G, Dabiri C, McHirgui A. et al. Uses of chitosan for treating different forms of serious obstetrics hemorrhages. J Gynecol Obstet Hum Reprod 2017; 46: 693-695
- 118 Dueckelmann AM, Hinkson L, Nonnenmacher A. et al. Uterine packing with chitosan-covered gauze compared to balloon tamponade for managing postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol 2019; 240: 151-155
- 119 Al-Harbi NA, Al-Abra ES, Alabbad NS. Utero-vaginal packing. Seven years review in the management of post partum hemorrhage due to placenta previa/accreta at a maternity hospital in Central Saudi Arabia. Saudi Med J 2009; 30: 243-246
- 120 Samartha Ram H, Shankar Ram HS, Panicker V. et al. Vacuum retraction of uterus for the management of atonic postpartum hemorrhage. IOSR J Dent Med Sci (IOSR-JDMS) 2014; 13: 15-19
- 121 Marasinghe JP. Control of Postpartum Hemorrhage Using Vacuum-Induced Uterine Tamponade. Obstet Gynecol 2016; 128: 910
- 122 Purwosunu Y, Sarkoen W, Arulkumaran S. et al. Control of Postpartum Hemorrhage Using Vacuum-Induced Uterine Tamponade. Obstet Gynecol 2016; 128: 33-36
- 123 Sentilhes L, Brun S, Madar H. et al. Control of Postpartum Hemorrhage Using Vacuum-Induced Uterine Tamponade. Obstet Gynecol 2016; 128: 909-910
- 124 DʼAlton ME, Rood KM, Smid MC. et al. Intrauterine Vacuum-Induced Hemorrhage-Control Device for Rapid Treatment of Postpartum Hemorrhage. Obstet Gynecol 2020; 136: 882-891
- 125 Hofmeyr GJ, Singata-Madliki M. Novel suction tube uterine tamponade for treating intractable postpartum haemorrhage: description of technique and report of three cases. BJOG 2020; 127: 1280-1283
- 126 Haslinger C, Weber K, Zimmermann R. Vacuum-Induced Tamponade for Treatment of Postpartum Hemorrhage. Obstet Gynecol 2021; 138: 361-365
- 127 Diemert A, Ortmeyer G, Hollwitz B. et al. The combination of intrauterine balloon tamponade and the B-Lynch procedure for the treatment of severe postpartum hemorrhage. Am J Obstet Gynecol 2012; 206: 65.e1-65.e4
- 128 Yoong W, Ridout A, Memtsa M. et al. Application of uterine compression suture in association with intrauterine balloon tamponade (‘uterine sandwich’) for postpartum hemorrhage. Acta Obstet Gynecol Scand 2012; 91: 147-151
- 129 Dhillon AS, Dhillon K. Use of combination method (uterine sandwich technique) to control postpartum hemorrhage. Int J Reprod Contracept Obstet Gynecol 2018; 7: 2753-2758
- 130 Seidel V, Braun T, Weizsacker K. et al. Application of chitosan-covered gauze in combination with intrauterine balloon tamponade for postpartum hemorrhage treatment – Case report of a novel “uterine sandwich” approach. Int J Surg Case Rep 2018; 48: 101-103
- 131 Nelson WL, OʼBrien JM. The uterine sandwich for persistent uterine atony: combining the B-Lynch compression suture and an intrauterine Bakri balloon. Am J Obstet Gynecol 2007; 196: e9-e10
- 132 Merrick K, Jibodu OA, Rajesh U. The difficult PPH: experience of combined use of B-Lynch brace suture and intrauterine Bakri balloon in York hospital, UK. J Obstet Gynaecol 2013; 33: 314-315
- 133 Cekmez Y, Ozkaya E, Ocal FD. et al. Experience with different techniques for the management of postpartum hemorrhage due to uterine atony: compression sutures, artery ligation and Bakri balloon. Ir J Med Sci 2015; 184: 399-402
- 134 Schlembach D, Mörtl MG, Girard T. et al. Management der postpartalen Blutung. Der D-A-CH-Algorithmus. Frauenarzt 2013; 54: 1072-1080
- 135 Carvajal JA, Ramos I, Kusanovic JP. et al. Damage-control resuscitation in obstetrics. J Matern Fetal Neonatal Med 2022; 35: 785-798
- 136 Deux JF, Bazot M, Le Blanche AF. et al. Is selective embolization of uterine arteries a safe alternative to hysterectomy in patients with postpartum hemorrhage?. AJR Am J Roentgenol 2001; 177: 145-149
- 137 Rath W, Hackethal A, Bohlmann MK. Second-line treatment of postpartum haemorrhage (PPH). Arch Gynecol Obstet 2012; 286: 549-561
- 138 Keogh J, Tsokos N. Aortic compression in massive postpartum haemorrhage–an old but lifesaving technique. Aust N Z J Obstet Gynaecol 1997; 37: 237-238
- 139 Riley DP, Burgess RW. External abdominal aortic compression: a study of a resuscitation manoeuvre for postpartum haemorrhage. Anaesth Intensive Care 1994; 22: 571-575
- 140 Pacheco LD, Lozada MJ, Saade GR. et al. Damage-Control Surgery for Obstetric Hemorrhage. Obstet Gynecol 2018; 132: 423-427
- 141 Yoong W, Lavina A, Ali A. et al. Abdomino-pelvic packing revisited: An often forgotten technique for managing intractable venous obstetric haemorrhage. Aust N Z J Obstet Gynaecol 2019; 59: 201-207
- 142 Kainer F. Damage Control Surgery: Operative Behandlungskonzepte im Sinne einer „Life Saving Strategy“ – Uteruserhaltende Methoden im Gegensatz zur PP-Hysterektomie: Sind Organerhalt oder Reduktion von Morbidität und Mortalität ein Widerspruch?. Speculum 2010; 28: 22-24
- 143 Hollatz-Galuschki E, Michaelis S, Rauber S. et al. Uteruskompressionsnähte – Welche Nahttechnik ist wann indiziert?. Geburtshilfe Frauenheilkd 2013; 73: P70
- 144 AbdRabbo SA. Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus. Am J Obstet Gynecol 1994; 171: 694-700
- 145 Morel O, Malartic C, Muhlstein J. et al. Pelvic arterial ligations for severe post-partum hemorrhage. Indications and techniques. J Visc Surg 2011; 148: e95-e102
- 146 Ahonen J, Stefanovic V, Lassila R. Management of post-partum haemorrhage. Acta Anaesthesiol Scand 2010; 54: 1164-1178
- 147 Rossi AC, Lee RH, Chmait RH. Emergency postpartum hysterectomy for uncontrolled postpartum bleeding: a systematic review. Obstet Gynecol 2010; 115: 637-644
- 148 Schols SE, Feijge MA, Lance MD. et al. Effects of plasma dilution on tissue-factor-induced thrombin generation and thromboelastography: partly compensating role of platelets. Transfusion 2008; 48: 2384-2394
- 149 Tanaka KA, Key NS, Levy JH. Blood coagulation: hemostasis and thrombin regulation. Anesth Analg 2009; 108: 1433-1446
- 150 Lier H, Hofer S, Annecke T. Anästhesiologisches Management der peripartalen Hämorrhagie. Anasthesiol Intensivmed Notfallmed Schmerzther 2020; 55: 686-701
- 151 Gillissen A, van den Akker T, Caram-Deelder C. et al. Association between fluid management and dilutional coagulopathy in severe postpartum haemorrhage: a nationwide retrospective cohort study. BMC Pregnancy Childbirth 2018; 18: 398
- 152 Futier E, Robin E, Jabaudon M. et al. Central venous O2 saturation and venous-to-arterial CO2 difference as complementary tools for goal-directed therapy during high-risk surgery. Crit Care 2010; 14: R193
- 153 Karlsson O, Jeppsson A, Hellgren M. Major obstetric haemorrhage: monitoring with thromboelastography, laboratory analyses or both?. Int J Obstet Anesth 2014; 23: 10-17
- 154 Mellin-Olsen J, Staender S, Whitaker DK. et al. The Helsinki Declaration on Patient Safety in Anaesthesiology. Eur J Anaesthesiol 2010; 27: 592-597
- 155 Grottke O, Frietsch T, Maas M. et al. German Society of Anaesthesiology and Intensive Care Medicine. [Dealing with massive bleeding and associated perioperative coagulopathy: recommendations for action of the German Society of Anaesthesiology and Intensive Care Medicine]. Anaesthesist 2013; 62: 213-216 218–220, 222–224
- 156 Einerson BD, Miller ES, Grobman WA. Does a postpartum hemorrhage patient safety program result in sustained changes in management and outcomes?. Am J Obstet Gynecol 2015; 212: 140-144.e1
- 157 Haslinger C, Korte W, Hothorn T. et al. The impact of prepartum factor XIII activity on postpartum blood loss. J Thromb Haemost 2020; 18: 1310-1319
- 158 Listyo S, Forrest E, Graf L. et al. The Need for Red Cell Support During Non-Cardiac Surgery Is Associated to Pre-Transfusion Levels of FXIII and the Platelet Count. J Clin Med 2020; 9: 2456
- 159 Wissenschaftlicher Beirat der Bundesärztekammer, Arbeitskreis „Querschnitts-Leitlinien Hämotherapie“. Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten – Gesamtnovelle 2020. Bundesärztekammer, Hrsg. 2020; Accessed June 18, 2023 at: https://www.bundesaerztekammer.de/fileadmin/user_upload/_old-files/downloads/pdf-Ordner/MuE/Querschnitts-Leitlinien_BAEK_zur_Therapie_mit_Blutkomponenten_und_Plasmaderivaten-Gesamtnovelle_2020.pdf Dt Ärzteblatt 2020; 117: A1883/B1603
- 160 Collins PW, Cannings-John R, Bruynseels D. et al. Viscoelastometric-guided early fibrinogen concentrate replacement during postpartum haemorrhage: OBS2, a double-blind randomized controlled trial. Br J Anaesth 2017; 119: 411-421
- 161 Collins PW, Lilley G, Bruynseels D. et al. Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study. Blood 2014; 124: 1727-1736
- 162 Collins PW, Bell SF, de Lloyd L. et al. Management of postpartum haemorrhage: from research into practice, a narrative review of the literature and the Cardiff experience. Int J Obstet Anesth 2019; 37: 106-117
- 163 Lier H, Rath W. Aktuelle interdisziplinäre Handlungsempfehlungen bei schweren peri-(post-)partalen Blutungen (PPH). Geburtshilfe Frauenheilkd 2011; 71: 577-588
- 164 Alfirevic Z, Elbourne D, Pavord S. et al. Use of recombinant activated factor VII in primary postpartum hemorrhage: the Northern European registry 2000–2004. Obstet Gynecol 2007; 110: 1270-1278
- 165 Barillari G, Frigo MG, Casarotto M. et al. Use of recombinant activated factor VII in severe post-partum haemorrhage: data from the Italian Registry: a multicentric observational retrospective study. Thromb Res 2009; 124: e41-e47
- 166 Phillips LE, McLintock C, Pollock W. et al. Recombinant activated factor VII in obstetric hemorrhage: experiences from the Australian and New Zealand Haemostasis Registry. Anesth Analg 2009; 109: 1908-1915
- 167 Huber AW, Raio L, Alberio L. et al. Recombinant human factor VIIa prevents hysterectomy in severe postpartum hemorrhage: single center study. J Perinat Med 2011; 40: 43-49
- 168 Lavigne-Lissalde G, Aya AG, Mercier FJ. et al. Recombinant human FVIIa for reducing the need for invasive second-line therapies in severe refractory postpartum hemorrhage: a multicenter, randomized, open controlled trial. J Thromb Haemost 2015; 13: 520-529
- 169 Colucci G, Helsing K, Biasiutti FD. et al. Standardized Management Protocol in Severe Postpartum Hemorrhage: A Single-Center Study. Clin Appl Thromb Hemost 2018; 24: 884-893
- 170 European Medicines Agency (EMA) – Committee for Medicinal Products for Human Use (CHMP). CHMP extension of indication variation assessment report: NovoSeven (Procedure No. EMEA/H/C/000074/II/0116). Accessed June 18, 2023 at: https://www.ema.europa.eu/en/documents/variation-report/novoseven-h-c-000074-ii-0116-epar-assessment-report-variation_en.pdf
- 171 Karanth L, Barua A, Kanagasabai S. et al. Desmopressin acetate (DDAVP) for preventing and treating acute bleeds during pregnancy in women with congenital bleeding disorders. Cochrane Database Syst Rev 2019; (02) CD009824
- 172 Trigg DE, Stergiotou I, Peitsidis P. et al. A systematic review: The use of desmopressin for treatment and prophylaxis of bleeding disorders in pregnancy. Haemophilia 2012; 18: 25-33
- 173 Kevane B, Donnelly J, DʼAlton M. et al. Risk factors for pregnancy-associated venous thromboembolism: a review. J Perinat Med 2014; 42: 417-425
- 174 Szecsi PB, Jorgensen M, Klajnbard A. et al. Haemostatic reference intervals in pregnancy. Thromb Haemost 2010; 103: 718-727
- 175 Karlsson O, Sporrong T, Hillarp A. et al. Prospective longitudinal study of thromboelastography and standard hemostatic laboratory tests in healthy women during normal pregnancy. Anesth Analg 2012; 115: 890-898
- 176 James AH, Konkle BA, Bauer KA. Prevention and treatment of venous thromboembolism in pregnancy in patients with hereditary antithrombin deficiency. Int J Womens Health 2013; 5: 233-241
- 177 Gallos G, Redai I, Smiley RM. The role of the anesthesiologist in management of obstetric hemorrhage. Semin Perinatol 2009; 33: 116-123
- 178 Kuczkowski KM. Anesthesia for the repeat cesarean section in the parturient with abnormal placentation: what does an obstetrician need to know?. Arch Gynecol Obstet 2006; 273: 319-321
- 179 Fuller AJ, Bucklin BA. Blood product replacement for postpartum hemorrhage. Clin Obstet Gynecol 2010; 53: 196-208
- 180 Bonnet MP, Deneux-Tharaux C, Bouvier-Colle MH. Critical care and transfusion management in maternal deaths from postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol 2011; 158: 183-188
- 181 Breymann C, Honegger C, Hösli I. et al. Diagnostik und Therapie der Eisenmangelanämie in der Schwangerschaft und postpartal. Expertenbrief Nr. 48 der Gynécologie Suisse SGGG (Kommission Qualitätssicherung). Gynäkologie 2017; 2: 31-34
- 182 Liu Y, Li X, Che X. et al. Intraoperative cell salvage for obstetrics: a prospective randomized controlled clinical trial. BMC Pregnancy Childbirth 2020; 20: 452
- 183 Khan KS, Moore P, Wilson M. et al. A randomised controlled trial and economic evaluation of intraoperative cell salvage during caesarean section in women at risk of haemorrhage: the SALVO (cell SALVage in Obstetrics) trial. Health Technol Assess 2018; 22: 1-88
- 184 Sullivan IJ, Ralph CJ. Obstetric intra-operative cell salvage: a review of an established cell salvage service with 1170 re-infused cases. Anaesthesia 2019; 74: 976-983
- 185 Catling S, Haynes SL. Coagulopathy during intraoperative cell salvage in a patient with major obstetric haemorrhage. Br J Anaesth 2011; 106: 749 author reply 750
- 186 Waldron S. Hypotension associated with leucocyte depletion filters following cell salvage in obstetrics. Anaesthesia 2011; 66: 133-134
- 187 de Lange NM, van Rheenen-Flach LE, Lance MD. et al. Peri-partum reference ranges for ROTEM(R) thromboelastometry. Br J Anaesth 2014; 112: 852-859
- 188 Agarwal S, Laycock HC. The debate ROTEMs on – the utility of point-of-care testing and fibrinogen concentrate in postpartum haemorrhage. Anaesthesia 2020; 75: 1247-1251
- 189 Wikkelso AJ, Edwards HM, Afshari A. et al. Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial. Br J Anaesth 2015; 114: 623-633
- 190 Allen L, Jauniaux E, Hobson S. et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management. Int J Gynaecol Obstet 2018; 140: 281-290
- 191 Sentilhes L, Kayem G, Chandraharan E. et al. FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management. Int J Gynaecol Obstet 2018; 140: 291-298
- 192 Collins SL, Alemdar B, van Beekhuizen HJ. et al. Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol 2019; 220: 511-526
- 193 Teixidor Vinas M, Chandraharan E, Moneta MV. et al. The role of interventional radiology in reducing haemorrhage and hysterectomy following caesarean section for morbidly adherent placenta. Clin Radiol 2014; 69: e345-e351
- 194 Teixidor Vinas M, Belli AM, Arulkumaran S. et al. Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after introduction of the Triple-P procedure. Ultrasound Obstet Gynecol 2015; 46: 350-355
- 195 Hsieh TT, Lee JD. Sonographic findings in acute puerperal uterine inversion. J Clin Ultrasound 1991; 19: 306-309
- 196 Pauleta JR, Rodrigues R, Melo MA. et al. Ultrasonographic diagnosis of incomplete uterine inversion. Ultrasound Obstet Gynecol 2010; 36: 260-261
- 197 Beringer RM, Patteril M. Puerperal uterine inversion and shock. Br J Anaesth 2004; 92: 439-441
- 198 You WB, Zahn CM. Postpartum hemorrhage: abnormally adherent placenta, uterine inversion, and puerperal hematomas. Clin Obstet Gynecol 2006; 49: 184-197
- 199 Witteveen T, van Stralen G, Zwart J. et al. Puerperal uterine inversion in the Netherlands: a nationwide cohort study. Acta Obstet Gynecol Scand 2013; 92: 334-337
- 200 Wilson AK, Martel MJ, Arsenault MY. et al. Maternal transport policy. J Obstet Gynaecol Can 2005; 27: 956-963
- 201 Wallwiener D, Beckmann MW. 219. Stellungnahme. Stellungnahme zur Frage der postoperativen Überwachung von Kaiserschnittpatientinnen. Geburtshilfe Frauenheilkd 2015; 75: 1216-1218
- 202 Gude P, Weber T. Geburtshilfliche Anästhesie und postoperative Überwachung. Practice Guidelines for Obstetric Anesthesia (ASA Task Force und SOAP) und Stellungnahme der DGAI/BDA zur postoperativen Überwachung nach Sectio. Anasthesiol Intensivmed Notfallmed Schmerzther 2018; 53: 696-702
- 203 Artyomenko VV, Nosenko VM. Anaesthesiologistsʼ simulation training during emergencies in obstetrics. Rom J Anaesth Intensive Care 2017; 24: 37-40
- 204 Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. Hum Resour Health 2020; 18: 2
- 205 Armenia S, Thangamathesvaran L, Caine AD. et al. The Role of High-Fidelity Team-Based Simulation in Acute Care Settings: A Systematic Review. Surg J (N Y) 2018; 4: e136-e151