Chapter 13b - Management of obstetric hemorrhage: anesthetic management

Summary

Once the diagnosis of obstetric hemorrhage has been made, early senior anesthetic involvement is vital. Blood pressure, oxygen saturation, and electrocardiogram (ECG) should be continuously monitored. Immediate resuscitation should begin with crystalloids and colloids. Hartmann's solution is the most physiologically balanced solution; normal saline can also be used, although it can itself cause metabolic acidosis after several liters have been used. Commonly available colloids include starches, gelatins, and albumin. Blood pressure, heart rate, and urine output are good endpoints in assessing adequate resuscitation. The prevention of hypothermia and acidosis is an essential component in the successful management of massive hemorrhage. Blood replacement should be guided by bedside and/or laboratory hemoglobin testing. A thromboelastogram (TEG) can be used to guide the replacement of coagulation factors. Cell salvage is now increasingly considered in massive obstetric hemorrhage as recent research has shown it to be safe in obstetrics.