Obstetrics and Gynecology International / 2009 / Article / Tab 4

Clinical Study

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

Table 4

Guidance for the use of rFVIIa in major obstetric haemorrhage

(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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