Obstetric hemorrhage: clinical protocol-based care

According to statistics obstetric hemorrhage is one of the leading causes of maternal mortality. The main reasons for this complication are placental abruption in late pregnancy, hypotonia of the uterus, coagulopathy, trauma to the uterus and birth canal injuries. Risk factors for bleeding are placenta previa, multiple pregnancy, women aged 40 or over. To reduce the complications of labour and delivery clinical practice guideline (Protocol) for prevention, treatment and care pathways or algorithms for management of obstetric hemorrhage have been developed and approved by the Ministry of Health of the Russian Federation. Prevention of postpartum hemorrhage involves refusal from unjustified induction of labour and other ways to start labour, unreasonable amniotomy, prohibited guidelines and cesarean section procedures based only on medical need. Administration of inhibitors of fibrinolysis and modern uterotonic (carbetocin) is also recommended. Management of obstetric hemorrhage includes conservative and surgical procedures. During the conservative stage, administration of fresh frozen plasma, inhibitors of fibrinolysis and uterotonics is suggested. It is also necessary to conduct adequate infusion and transfusion therapy (crystalloids solutions, colloids and modified gelatin). Surgical procedures include minimally invasive operative treatment (intrauterine balloon tamponade, uterine compression sutures) and as a last resort surgical removal of the uterus (hysterectomy). Strict adherence to the abovementioned algorithm in women with postpartum hemorrhage will help obstetrician-gynaecologists to save not only the woman's life but her fertility function as well.