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| Guidance for the use of rFVIIa in major obstetric haemorrhage |
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| (i) Use of rFVIIa should be considered in major obstetric haemorrhage: |
| -which continues despite optimal blood product replacement and obstetric measures. |
| -where uterine artery ligation/embolisation or hysterectomy are under consideration. |
| -with clinical haemostatic failure (i.e., oozing from multiple sites), where there is unavoidable delay in the provision of |
| blood products. |
| -in women who refuse blood or blood components, for example, Jehovah’s Witness |
| (ii) A dose of 90 g/kg is recommended |
| (iii) Use of rFVIIa should be authorised by a Consultant Haematologist or Consultant Obstetric Anaesthetist prior to administration. |
| (iv) A single standard dose should be kept in delivery suite to facilitate rapid administration in appropriate circumstances. |
| (v) Use of rFVIIa should not be seen as an alternative to surgical haemostasis or correction of coagulopathy with blood products. Before |
| administration of rFVIIa, the following laboratory indices are desirable; |
| –Prothrombin time < 1.5 upper limit of normal |
| –Clauss fibrinogen > 1.0 g/L |
| –Platelet count > 50 109/L |
| (vi) Along with the above laboratory indices a pH > 7.1 is also desirable for optimal effect. |
| (vii) Further doses should only be given in exceptional circumstances where agreed by the multidisciplinary team, for example, where |
| exsanguination seems likely. |
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