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Chapter 13c - Management of obstetric hemorrhage: hemostatic management

from Section 5 - Hemorrhagic disorders

Published online by Cambridge University Press:  06 December 2010

By
Eleftheria Lefkou  and
Beverley Hunt
Edited by
Sue Pavord  and
Beverley Hunt
Sue Pavord
Affiliation:
Leicester Royal Infirmary
Beverley Hunt
Affiliation:
Guy's and St Thomas' NHS Foundation Trust
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Summary

Current best practice for the hematological management of obstetric hemorrhage (OH) emphasizes the need for speedy and appropriate use of blood components with close monitoring of blood loss. This chapter gives practical guidelines for the hematological management of OH. Red blood cell (RBC) transfusion is a first-line intervention to treat the inadequate oxygen delivery seen in OH. The platelet count should be checked 10-15 minutes after platelet infusion to ensure the adequacy of therapy. A poor increment of less than 20 x 109/L after 15 minutes in a patient without ongoing bleeding to suggest the presence of antiplatelet antibodies, usually human leukocyte antigen (HLA) antibodies. The indications for use of fresh frozen plasma (FFP) in massive transfusion and disseminated intravascular coagulation with significant bleeding are PT or APTT ratio 1.5. Regular full blood counts (FBCs) and coagulation screens should be used to guide therapy, with regular requests with massive loss.

Keywords

HDNmaternal red cell antibodyneonatal alloimmune thrombocytopeniaRhD isoimmunizationplacentared cell alloimmunization
Type
Chapter
Information
The Obstetric Hematology Manual , pp. 166 - 170
Publisher: Cambridge University Press
Print publication year: 2010

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