Journal de gynécologie, obstétrique et biologie de la reproduction
-
J Gynecol Obstet Biol Reprod (Paris) · Dec 2014
Review[Anesthetic management of severe or worsening postpartum hemorrhage.]
Risk factors of maternal morbidity and mortality during postpartum hemorrhage (PPH) include non-optimal anesthetic management. As the anesthetic management of the initial phase is addressed elsewhere, the current chapter is dedicated to the management of severe PPH. ⋯ The anesthetic management aims to restore and maintain optimal respiratory state and circulation, to treat coagulation disorders, and to allow invasive obstetrical and radiologic procedures. Clinical and instrumental monitoring are needed to evaluate the severity of PPH, to guide the choice of therapeutic options, and to assess treatments efficacy.
-
Produce recommendations for the management of placenta previa and placenta accrete. ⋯ Placental insertion abnormalities require anesthetic and obstetric coordination. Delivery must be planned in a suitable structure.
-
J Gynecol Obstet Biol Reprod (Paris) · Dec 2014
Review[Obstetric and anesthetic specificities in the management of a postpartum hemorrhage (PPH) associated with cesarean section.]
To describe the characteristics of post-partum hemorrhage (PPH) associated with cesarean section (CS), the modalities diagnosis and specific obstetric and anesthetic management. ⋯ The occurrence of PPH associated with cesarean delivery requires close collaboration between obstetrician and anesthesiologist to ensure a rapid and coordinated management (professional consensus).
-
J Gynecol Obstet Biol Reprod (Paris) · Dec 2014
Review[Clinical and pharmacological procedures for the prevention of postpartum haemorrhage in the third stage of labor.]
To describe the clinical and pharmacological procedures for the prevention of Postpartum Haemorrhage (PPH). ⋯ Vaginal birth: only the use of uterotonics reduces the incidence of PPH. Oxytocin is the treatment of choice if it is readily available (grade A). Oxytocin can be used either after the shoulders expulsion or rapidly after the placental delivery (grade B). A dose of 5 or 10IU must be administrated IV over at least 1minute or directly by an intramuscular injection (professional agreement) except in women with documented cardiovascular disease in which the duration of the IV perfusion should be over at least 5minutes (professional agreement). Mechanical procedures have no significant impact on PPH. The decision to use a collector bag is left to the medical team (professional agreement). A systematic complementary oxytocin perfusion is not recommended (professional agreement). Caesarean delivery: There is no evidence to recommend a particular type of caesarean technique to prevent PPH (professional agreement) but a lower uterine section is recommended (grade B). All types of incision expansion may be used (professional agreement). A controlled cord traction is associated with lower blood losses than manual removal of the placenta (grade B). A dose of 5 or 10IU can be injected (IV) over 1minute, and over 5minutes in women with cardiovascular disease (professional agreement). Carbetocin reduces the incidence of PPH but there is presently no inferiority study comparing oxytocin and carbetocin so that oxytocin remains the gold standard therapy to prevent PPH in C-section (professional agreement).