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Eur J Obstet Gynecol Reprod Biol. 2016 Mar;198:12-21. doi: 10.1016/j.ejogrb.2015.12.012. Epub 2015 Dec 21.

Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR).

Author information

1
Service de Gynécologie-Obstétrique, CHU Bordeaux, 33076 Bordeaux, France. Electronic address: loicsentilhes@hotmail.com.
2
Service de Gynécologie-Obstétrique, Hôpital Paule de Viguier, CHU Toulouse, 31059 Toulouse, France; UMR 1027 Inserm Université Toulouse III « Epidémiologie Périnatale et handicap de l'enfant, Santé des adolescents », 31000 Toulouse, France.
3
INSERM U1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Paris, France.
4
Département Anesthésie-Douleur, Groupe Hospitalo-Universitaire Caremeau, Place du Pr Debré, 30029 Nîmes Cedex 09, France; EA2992 - Faculté de médecine Montpellier-Nîmes, 186, chemin du carreau-de-Lanes, 30029 Nîmes Cedex 2, France.
5
CHU de Toulouse, Pole d'anesthésie Réanimation, Hôpital Paule de Viguier, Toulouse F-31059, France.
6
INSERM U1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Paris, France; Département d'anesthésie-réanimation, Hôpital Cochin, APHP, université Paris-Descartes, Paris, France.
7
Etablissement Français du Sang, 20, Avenue du Stade de France, 93218 La Plaine Saint-Denis Cedex, France.
8
Service de Gynécologie-Obstétrique, CHU Caen et UFR de Médecine Caen, 14033 Caen, France.
9
Service de Gynécologie-Obstétrique, CHU Caen et UFR de Médecine Caen, 14033 Caen, France; UFR de Médecine Caen, 14033 Caen, France.
10
Association d'usagers, Collectif interassociatif autour de la naissance (CIANE), Paris, France.
11
Réseau périnatal Aurore - Hôpital de la Croix Rousse, université Lyon 1, Lyon, France; EA 4129, laboratoire « Santé, individu, société », faculté de médecine Laennec, 69372 Lyon, France.
12
Etablissement Français du Sang Ile de France, site de l'Hôpital Européen Georges-Pompidou, APHP, Paris, France.
13
Service de Gynécologie-Obstétrique, CHU Estaing, 63003 Clermont-Ferrand, France; R2D2-EA7281, Université d'Auvergne, 63000 Clermont-Ferrand, France.
14
Service de Gynécologie-Obstétrique, CHU Marseille, Hôpital Nord, AP-HM, 13015 Marseille, France.
15
Réseau périnatal Aurore - Hôpital de la Croix Rousse, université Lyon 1, Lyon, France; INSERM U846, Stem Cell and Brain Research Institute, Lyon, France.
16
Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, 92701 Colombes, France.
17
Service d'Anesthésie, CHU Louis-Mourier, AP-HP/Université Paris-7, 178, rue des Renouilliers, 92700 Colombes, France; Université Paris-Diderot, Sorbonne Paris Cité, EA recherche clinique coordonnée ville-hôpital, méthodologies et société (REMES), 75010 Paris, France.
18
Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg, France.
19
Service d'Obstétrique et de Médecine fœtale, Pôle de Gynécologie-Obstétrique, CHU de Nancy, Université de Lorraine, 10 rue Heydenreich, 54000 Nancy, France.
20
Inserm, UMR1027, Toulouse F-31073, France; Université de Toulouse III, UMR1027, Toulouse F-31073, France; CHU Toulouse, Pole de Gynécologie Obstétrique, Hôpital Paule de Viguier, Toulouse F-31059, France.
21
Département de Radiologie, CHU Caen, 14033 Caen, France.
22
Département d'Anesthésie Réanimation SMUR, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, France.
23
Collège National des Sages-Femmes, France; DHU Risques et Grossesse, 53 avenue de l'observatoire, Paris, France.
24
Société Française d'Anesthésie et de Réanimation, France; Département d'Anesthésie, Hôpital Antoine Béclère, APHP, Clamart, France; Faculté de Médecine de K. Bicêtre, Université Paris-Sud, France.
25
INSERM U1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Paris, France; DHU Risques et Grossesse, 53 avenue de l'observatoire, Paris, France; Maternité Port-Royal, Université Paris Descartes, Groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France.

Abstract

Postpartum haemorrhage (PPH) is defined as blood loss ≥500mL after delivery and severe PPH as blood loss ≥1000mL, regardless of the route of delivery (professional consensus). The preventive administration of uterotonic agents just after delivery is effective in reducing the incidence of PPH and its systematic use is recommended, regardless of the route of delivery (Grade A). Oxytocin is the first-line prophylactic drug, regardless of the route of delivery (Grade A); a slowly dose of 5 or 10 IU can be administered (Grade A) either IV or IM (professional consensus). After vaginal delivery, routine cord drainage (Grade B), controlled cord traction (Grade A), uterine massage (Grade A), and routine bladder voiding (professional consensus) are not systematically recommended for PPH prevention. After caesarean delivery, placental delivery by controlled cord traction is recommended (grade B). The routine use of a collector bag to assess postpartum blood loss at vaginal delivery is not systematically recommended (Grade B), since the incidence of severe PPH is not affected by this intervention. In cases of overt PPH after vaginal delivery, placement of a blood collection bag is recommended (professional consensus). The initial treatment of PPH consists in a manual uterine examination, together with antibiotic prophylaxis, careful visual assessment of the lower genital tract, a uterine massage, and the administration of 5-10 IU oxytocin injected slowly IV or IM, followed by a maintenance infusion not to exceed a cumulative dose of 40IU (professional consensus). If oxytocin fails to control the bleeding, the administration of sulprostone is recommended within 30minutes of the PPH diagnosis (Grade C). Intrauterine balloon tamponade can be performed if sulprostone fails and before recourse to either surgery or interventional radiology (professional consensus). Fluid resuscitation is recommended for PPH persistent after first line uterotonics, or if clinical signs of severity (Grade B). The objective of RBC transfusion is to maintain a haemoglobin concentration (Hb) >8g/dL. During active haemorrhaging, it is desirable to maintain a fibrinogen level ≥2g/L (professional consensus). RBC, fibrinogen and fresh frozen plasma (FFP) may be administered without awaiting laboratory results (professional consensus). Tranexamic acid may be used at a dose of 1 g, renewable once if ineffective the first time in the treatment of PPH when bleeding persists after sulprostone administration (professional consensus), even though its clinical value has not yet been demonstrated in obstetric settings. It is recommended to prevent and treat hypothermia in women with PPH by warming infusion solutions and blood products and by active skin warming (Grade C). Oxygen administration is recommended in women with severe PPH (professional consensus). If PPH is not controlled by pharmacological treatments and possibly intra-uterine balloon, invasive treatments by arterial embolization or surgery are recommended (Grade C). No technique for conservative surgery is favoured over any other (professional consensus). Hospital-to-hospital transfer of a woman with a PPH for embolization is possible once hemoperitoneum is ruled out and if the patient's hemodynamic condition so allows (professional consensus).

KEYWORDS:

Oxytocin; Peripartum hysterectomy; Placenta accreta; Postpartum hemorrhage; Transfusion

PMID:
26773243
DOI:
10.1016/j.ejogrb.2015.12.012
[Indexed for MEDLINE]

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