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 bleeding	Time from start of bleeding to rFVIIa administration (hours:minutes)	No. of rFVIIa doses administered	Measures taken to secure haemostasis before rFVIIa	Measures taken to secure haemostasis after rFVIIa	Blood loss following rFVIIa
1	33	Uterine atony	12:35	1	Uterotonics, curettage, uterine packing	Nil	Stopped
2	34	Post emergency Caesarean section	20:33	1	Aprotinin, ligation of broad ligament bleed point	Bilateral iliac artery ligation, splenectomy	Stopped
3	30	Retained placenta, uterine perforation	2:00	1	TAH (rFVIIa given intraoperatively)	Nil	Stopped
4	30	Placental abruption	9:15	1	Uterotonics	Nil	Stopped
5	38	Uterine atony following exit procedure	1:59	1	Uterotonics	Nil	Decreased
6	20	Uterine atony, vaginal lacerations	2:57	1	Uterotonics, Rusch balloon	Nil	Decreased
7	34	Intrapartum bleeding with uterine atony following emergency Caesarean section	5:10	3	Uterotonics, Rusch balloon, TAH (1st dose rFVIIa given intraoperatively)	2nd rVIIa followed by 4 vessel embolisation, 3rd rFVIIA followed by repair bladder tear and further embolisation	Decreased
8	46	Placenta accreta and placenta praevia,	4:35	1	TAH	Laparotomy but no bleeding point found.	Decreased
9	32	Placenta praevia (Jehovah’s Witness)	8:00	1	Uterotonics, antifibrinolytics, B-Lynch suture	TAH	Decreased
10	36	Placental abruption during road traffic accident	5:00	1	Uterotonics, laparotomy and intra-abdominal packing	Nil	Decreased
11	38	Placenta praevia	3:05	1	Balloon tamponade, vaginal packing	Nil	Decreased
12	36	Uterine eversion	1:00	1	Uterotonics, uterine packing, vessel embolisation, TAH (rFVIIa given intraoperatively)	Repeat laparotomy and abdominal packing	Decreased
13	21	Placenta praevia	3:30	1	Uterotonics, antifibrinolytics	TAH	Unchanged
14	43	Post elective Caesarean section, broad ligament tear	4:05	1	Laparotomy and repair of tear	Subtotal hysterectomy	Unchanged
15	20	Uterine atony	3:00	1	Uterotonics, uterine packing, B-Lynch suture, iliac artery ligation,	TAH	Unchanged