Anesthetic Considerations and Management of Obstetric Hemorrhage

Massive obstetric hemorrhage (MOH) remains a significant cause of maternal morbidity and mortality worldwide. Causes may be antepartum, intrapartum, and postpartum bleeding. This review highlights the various factors responsible for MOH, its management and the most recent treatment guidelines. Team responses that emphasize the accurate estimation of blood loss, early warning signs of shock, rapid response to blood loss, and coagulopathy will lead to reduction in maternal morbidity. The hemostatic management of major obstetric hemorrhage is a major challenge for both anesthesiologist and obstetricians. Bleeding leads to consumption of coagulation factors which may be exacerbated by dilutional coagulopathy after volume resuscitation. Many laboratory-based tests like plasma fibrinogen concentration and platelet count are unsuitable for emergency use due to their long turnaround times, so they have limited value for the management of PPH. Current evidence suggests that viscoelastic monitoring using thromboelastography or thromboelastometry based tests may be useful for rapid assessment and for guiding hemostatic therapy during acute hemorrhage. Intraoperative blood salvage may be life-saving in cases of intractable hemorrhage if banked blood is not available. The safety and efficacy of recombinant activated factor VII therapy have not been fully evaluated in the treatment of obstetric hemorrhage.