Hemostatic assessment, treatment strategies, and hematology consultation in massive postpartum hemorrhage: results of a quantitative survey of obstetrician-gynecologists.

James, Andra H

Cooper, David L

Paidas, Michael J

New Zealand

2016-02-04T21:46:27Z

2015

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.

http://www.ncbi.nlm.nih.gov/pubmed/26604829

ijwh-7-873

https://hdl.handle.net/10161/11597

eng

Informa UK Limited

Int J Womens Health

10.2147/IJWH.S89573

acquired hemophilia

blood coagulation disorders

disseminated intravascular coagulation

von Willebrand disease

Hemostatic assessment, treatment strategies, and hematology consultation in massive postpartum hemorrhage: results of a quantitative survey of obstetrician-gynecologists.

Journal article

James, Andra H|0000-0003-4570-6595

http://www.ncbi.nlm.nih.gov/pubmed/26604829

873

881

Clinical Science Departments

Duke

Medicine

Medicine, Hematology

Midwifery Service

Obstetrics and Gynecology

Obstetrics and Gynecology, Maternal Fetal Medicine

School of Medicine

Published online

7