Obstetrics and Gynecology International / 2009 / Article / Tab 1

Clinical Study

Recombinant Activated Factor VII (rFVIIa) in the Management of Major Obstetric Haemorrhage: A Case Series and a Proposed Guideline for Use

Table 1

Clinical indication and response to rFVIIa following major obstetric haemorrhage. rFVIIa—recombinant activated factor VII, TAH—total abdominal hysterectomy.

Pt no.Maternal age (years)Cause of bleedingTime from start of bleeding to rFVIIa administration (hours:minutes)No. of rFVIIa doses administeredMeasures taken to secure haemostasis before rFVIIaMeasures taken to secure haemostasis after rFVIIaBlood loss following rFVIIa

133Uterine atony12:351Uterotonics, curettage, uterine packingNilStopped
234Post emergency Caesarean section20:331Aprotinin, ligation of broad ligament bleed pointBilateral iliac artery ligation, splenectomyStopped
330Retained placenta, uterine perforation2:001TAH (rFVIIa given intraoperatively)NilStopped
430Placental abruption9:151UterotonicsNilStopped
538Uterine atony following exit procedure1:591UterotonicsNilDecreased
620Uterine atony, vaginal lacerations2:571Uterotonics, Rusch balloonNilDecreased
734Intrapartum bleeding with uterine atony following emergency Caesarean section5:103Uterotonics, Rusch balloon, TAH (1st dose rFVIIa given intraoperatively)2nd rVIIa followed by 4 vessel embolisation, 3rd rFVIIA followed by repair bladder tear and further embolisationDecreased
846Placenta accreta and placenta praevia,4:351TAHLaparotomy but no bleeding point found.Decreased
932Placenta praevia (Jehovah’s Witness)8:001Uterotonics, antifibrinolytics, B-Lynch sutureTAHDecreased
1036Placental abruption during road traffic accident5:001Uterotonics, laparotomy and intra-abdominal packingNilDecreased
1138Placenta praevia3:051 Balloon tamponade, vaginal packingNilDecreased
1236Uterine eversion1:001Uterotonics, uterine packing, vessel embolisation, TAH (rFVIIa given intraoperatively)Repeat laparotomy and abdominal packingDecreased
1321Placenta praevia3:301Uterotonics, antifibrinolyticsTAHUnchanged
1443Post elective Caesarean section, broad ligament tear4:051Laparotomy and repair of tearSubtotal hysterectomyUnchanged
1520Uterine atony3:001Uterotonics, uterine packing, B-Lynch suture, iliac artery ligation,TAHUnchanged

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