Recombinant human factor VIIa prevents hysterectomy in severe postpartum hemorrhage: single center study

Huber, Alexander W; Raio, Luigi; Alberio, Lorenzo; Ghezzi, Fabio; Surbek, Daniel V (2012). Recombinant human factor VIIa prevents hysterectomy in severe postpartum hemorrhage: single center study. Journal of perinatal medicine, 40(1), pp. 43-9. Berlin: Walter de Gruyter 10.1515/JPM.2011.109

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Abstract Objective: To evaluate the effectiveness of human recombinant activated factor VII (rhFVIIa, NovoSeven) in avoiding hysterectomy postpartum in the management of severe postpartum hemorrhage (PPH). Methods: We performed a prospective cohort study at our university tertiary care center. Patients with severe post partum hemorrhage (blood loss >2000 mL) and failed medical and uterus-preserving surgical management, were treated with intravenous bolus administration of rhVIIa. Main outcome measures were cessation of bleeding, postpartum hysterectomy and thromboembolic events. Results: In 20/22 patients included, PPH was caused primarily by uterine atony, including 7 (32%) with additional lower genital tract lesion; in two women, it was due to pathologic placentation (placenta increta, 9%). One case of amniotic fluid embolism and one woman with uterine inversion were included. Recombinant hFVIIa was successful in stopping the PPH and in preventing a hysterectomy in 20/22 women (91%). The remaining two patients with persistent bleeding despite rhFVIIa treatment, who underwent postpartum hysterectomy, had placenta increta. No thromboembolic event was noticed. Conclusions: This study describes the largest single center series of rhFVIIa treatment for fertility preservation in severe postpartum hemorrhage published to date. Our data suggest that administration of rhFVIIa is effective in avoiding postpartum hysterectomy after conservative medical and surgical measures have failed. Although randomized studies are lacking, rhFVIIa should be considered as a second-line therapeutic option of life-threatening postpartal bleeding, in particular if preservation of fertility is warranted and hysterectomy is to be avoided.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Gynaecology

UniBE Contributor:

Raio, Luigi and Surbek, Daniel

ISSN:

0300-5577

Publisher:

Walter de Gruyter

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:21

Last Modified:

22 Oct 2019 17:19

Publisher DOI:

10.1515/JPM.2011.109

PubMed ID:

22017328

Web of Science ID:

000300652600006

BORIS DOI:

10.7892/boris.7144

URI:

https://boris.unibe.ch/id/eprint/7144 (FactScience: 212320)

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