Hemostatic assessment, treatment strategies, and hematology consultation in massive postpartum hemorrhage: results of a quantitative survey of obstetrician-gynecologists.
Abstract
OBJECTIVE: To assess potential diagnostic and practice barriers to successful management
of massive postpartum hemorrhage (PPH), emphasizing recognition and management of
contributing coagulation disorders. STUDY DESIGN: A quantitative survey was conducted
to assess practice patterns of US obstetrician-gynecologists in managing massive PPH,
including assessment of coagulation. RESULTS: Nearly all (98%) of the 50 obstetrician-gynecologists
participating in the survey reported having encountered at least one patient with
"massive" PPH in the past 5 years. Approximately half (52%) reported having previously
discovered an underlying bleeding disorder in a patient with PPH, with disseminated
intravascular coagulation (88%, n=23/26) being identified more often than von Willebrand
disease (73%, n=19/26). All reported having used methylergonovine and packed red blood
cells in managing massive PPH, while 90% reported performing a hysterectomy. A drop
in blood pressure and ongoing visible bleeding were the most commonly accepted indications
for rechecking a "stat" complete blood count and coagulation studies, respectively,
in patients with PPH; however, 4% of respondents reported that they would not routinely
order coagulation studies. Forty-two percent reported having never consulted a hematologist
for massive PPH. CONCLUSION: The survey findings highlight potential areas for improved
practice in managing massive PPH, including earlier and more consistent assessment,
monitoring of coagulation studies, and consultation with a hematologist.
Type
Journal articleSubject
acquired hemophiliablood coagulation disorders
disseminated intravascular coagulation
von Willebrand disease
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https://hdl.handle.net/10161/11597Published Version (Please cite this version)
10.2147/IJWH.S89573Publication Info
James, Andra H; Cooper, David L; & Paidas, Michael J (2015). Hemostatic assessment, treatment strategies, and hematology consultation in massive
postpartum hemorrhage: results of a quantitative survey of obstetrician-gynecologists.
Int J Womens Health, 7. pp. 873-881. 10.2147/IJWH.S89573. Retrieved from https://hdl.handle.net/10161/11597.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Andra Hohler James
Professor Emeritus of Obstetrics and Gynecology
I am an OB-GYN and a specialist in maternal-fetal medicine and high-risk obstetrics.
My research and publications pertain mainly to the care of women with blood disorders
(thrombosis and thrombophilia), bleeding disorders (including von Willebrand disease),
platelet disorders (including ITP), and sickle cell disease.

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