Title

Emerging Technology for Early Detection and Management of Postpartum Hemorrhage to Prevent Morbidity

Document Type

Journal Article

Publication Date

9-5-2022

Journal

American journal of obstetrics & gynecology MFM

DOI

10.1016/j.ajogmf.2022.100742

Keywords

ROTEM; TEG; compensatory reserve; postpartum hemorrhage; postpartum hemorrhage detection; thromboelastography; thromboelastometry; viscoelastic hemostasis assays

Abstract

Despite advances in hemorrhage detection and management, postpartum hemorrhage remains the single leading cause of maternal death worldwide. Within the United States, hemorrhage is the leading cause of maternal death on the day of delivery and within the first week postpartum. Blood transfusion following hemorrhage represents a large proportion of severe maternal morbidity during and after delivery. Blood loss during delivery has historically been assessed visually by inspecting soiled pads, linens, and laparotomy sponges. These methods underestimate the volume of blood loss by as much as 40%, becoming increasingly inaccurate as blood loss increases. Young, healthy obstetric patients compensate for blood loss via peripheral vasoconstriction, maintaining heart rate and blood pressure in a normal range until over one liter of blood has been lost. A significant decrease in blood pressure along with marked tachycardia (>120bpm) may not be seen until 30-40% of blood volume has been lost, or 2-2.6L in a healthy term pregnant patient, after which the patient may rapidly decompensate. In resource-poor settings especially, the narrow window between the emergence of significant vital sign abnormalities and clinical decompensation may prove catastrophic. Once hemorrhage is detected, decisions regarding blood product transfusion are routinely made based on inaccurate estimates of blood loss, placing patients at risk of under-resuscitation (increasing the risk of hemorrhagic shock and end-organ damage) or over over-resuscitation (increasing the risk of transfusion reaction, fluid overload, and alloimmunization). We will review novel technologies which have emerged to assist both in the early and accurate detection of postpartum hemorrhage, and in decisions regarding blood product transfusion.

Department

Obstetrics and Gynecology

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