Emergency treatment of massive obstetric haemorrhage
Call for help (Most senior obstetric anaesthetist and obstetrician)
Airway  Breathing Circulation Drugs/disability Emergency surgery
Oxygen 100% via a facemask
Full left lateral for APH – Head down, legs up
Two large-bore i.v. cannulae
Take blood at the same time for: Crossmatch 6 units Full blood count Coagulation studies
Communication is vital: Mobilise porters Notify theatre staff, request a cell saver with separate suction for amniotic fluid Alert the blood bank and haematologist
Concurrently: Warm all resuscitation fluids, Crystalloid, 2 litres maximum Colloid, 1.5 litre maximum Use group specific or O Rh negative blood whilst waiting Ask somebody to set up a Level 1 warmer and Rapid infusion (or similar) device Monitor haematocrit and haemoglobin Restore normovolaemia
If massive bleeding continues: Give 4 units FFP and 10 units cryoprecipitate Consider platelets Use coagulation studies to guide the use of further blood products Peri-operative monitoring as per the AAGBI guidelines Consider invasive monitoring
Drugs to consider: Oxytocin (postpartum haemorrhage, given slowly) Ergometrine (postpartum haemorrhage) Carboprost (Hemabate, postpartum haemorrhage, not in asthmatic) Tocolytic drugs (Placenta praevia and uterine rupture, beware of hypotension) Antifibrinolytics if no contraindications rFVIIa (NovoSeven)
References:
[i] BJA-CEACCP; Massive haemorrhage in pregnancy
[ii] UK Blood Transfusion & Tissue Transplantation Services
[iii] AAGBI - Blood Transfusion and the Anaesthetist
[iv] AAGBI - Standards of Monitoring
[v] Entrez PubMed; Treatment of life threatening bleeding in O&G, NovoSeven (rFVIIa)
ArticleDate:20060603
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