Courtois L, Becher P, Miot S, Maisonnette-Escot Y, Sautière J-L, Berthier F, Samain E, Maillet R, Riethmuller D
Service de Gynécologie Obstétrique, CHU Saint-Jacques, 2, place Saint-Jacques, 25000 Besançon, France.
J Gynecol Obstet Biol Reprod (Paris). 2007 Feb;36(1):78-82. doi: 10.1016/j.jgyn.2006.09.002. Epub 2007 Jan 10.
Postpartum haemorrhage remains a dangerous obstetrical complication, which is the main cause of maternal mortality in developing countries. The diagnosis must be immediate and its management is both medically and surgically in life-threatening haemorrhage. We present a case of a thirty-three-year-old woman who asked a pregnancy interruption for premature rupture of membranes at 21(th) gestational week for her second pregnancy; she underwent a caesarean section at term for her first pregnancy. She delivered vaginally and developed a postpartum haemorrhage with hemorrhagic shock which was resistant to medical, surgical and radiological management. We decided to use recombinant activated factor VII (rFVIIa, NovoSeven) as a final attempt to rescue the patient. During surgery, two intravenous bolus injections (60, 120 mug/kg) were successfully given with a control of bleeding and haemoglobin. The patient developed later a splenic thrombosis that can be related to either rFVIIa or to the hypovolemic shock or to the sepsis. Recombinant activated factor VII is an interesting and promising haemostatic agent in the management of life-threatening postpartum haemorrhage unresponsive to conventional treatment.
