Treatment of obstetric hemorrhage with recombinant activated factor VII

Introduction

Massive postpartum bleeding remains a major cause of maternal morbidity and death. An estimated 90% of such deaths might be preventable.

Methods

rFVIIa was used in our ICU in the treatment of 12 women with severe or life-threatening postpartum bleeding (PPB) in 2005 to 2008 due to placenta previa accrete, rupture of the uterus and pre-eclampsia with haemolysis, elevated liver enzymes and low platelets. The average patient age was 30 years. We used the questioners of Novo Nordisk to assess the indications and effectiveness of treatment. All patients had normal coagulation parameters before surgery. We compared the amount of blood loss within 12 hours before and 12 hours after giving rFVIIa, the dynamics of bleeding (assessed in ml/hour) before and after treatment and coagulation profile parameters. We used small doses of rFVIIa (15.25 to 50 μg/kg). We used Student's t test for statistical analysis of the laboratory data prior to and after rFVIIa.

Results

Indications for administration of rFVIIa were considered when sudden blood loss exceeded 1,800 ml or when continuing blood loss of 500 ml/hour (in the drain). Patients after rFVIIa treatment received a lower number of packed red cell transfusions (4.0 ± 4.46 vs. 9.61 ± 6.7, P = 0.007), compared with before treatment. In addition, the median amount of crystalloid/colloids administered decreased markedly. After administration, rFVIIa bleeding stopped in eight patients. Bleeding markedly decreased in two patients during 3 hours. Two patients who did not benefit from initial rFVIIa administration received additional drug in a dose of 35.65 μg/kg with good results. No adverse effects were directly related to treatment with rFVIIa.

Conclusion

Clinical reports and hematologic data suggest improvement for more than 80% of women after rVIIa administration.