SUNY Downstate Medical Center, 450 Clarkson Ave., Box 6, Brooklyn, NY 11203, USA.
Br J Anaesth. 2009 Dec;103 Suppl 1:i47-56. doi: 10.1093/bja/aep303.
Maternal haemorrhage is the leading cause of preventable maternal death worldwide and encompasses antepartum, intrapartum, and postpartum bleeding. This review highlights factors that predispose to severe bleeding, its management, and the most recent treatment and guidelines. Advances in obstetric care have provided physicians with the diagnostic tools to detect, anticipate, and prevent severe life-threatening maternal haemorrhage in most patients who have had prenatal care. In an optimal setting, patients at high risk for haemorrhage are referred to tertiary care centres where multidisciplinary teams are prepared to care for and deal with known potential complications. However, even with the best prenatal care, unexpected haemorrhage occurs. The first step in management is stabilization of haemodynamic status, which involves securing large bore i.v. access, invasive monitoring, and aggressive fluid management and transfusion therapy. Care for the patient with maternal bleeding should follow an algorithm that goes through a rapid and successive sequence of medical and surgical approaches to stem bleeding and decrease morbidity and mortality. With the addition of potent uterotonic agents and the advent of minimally invasive interventional radiological techniques such as angiographic embolization and arterial ligation, definitive yet conservative management is now possible in an attempt to avoid hysterectomy in patients with severe peripartum bleeding. If these interventions are inadequate to control the bleeding, the decision to proceed to hysterectomy must be made expeditiously. Recombinant factor VIIa is a relatively new treatment that could prove useful for severe coagulopathy and intractable bleeding.
产妇出血是全球可预防产妇死亡的主要原因，包括产前、产时和产后出血。本综述重点介绍了导致严重出血的因素、其处理方法以及最新的治疗和指南。产科护理的进步为医生提供了诊断工具，以便在大多数接受产前护理的患者中发现、预测和预防危及生命的严重产妇出血。在理想的情况下，高出血风险的患者被转介到三级保健中心，那里的多学科团队已准备好照顾和处理已知的潜在并发症。然而，即使有最好的产前护理，也会出现意想不到的出血。管理的第一步是稳定血液动力学状态，这涉及确保大口径静脉内通路、有创监测以及积极的液体管理和输血治疗。对产妇出血患者的护理应遵循一个算法，该算法通过快速连续的医疗和手术方法来止血，降低发病率和死亡率。随着强效子宫收缩剂的加入和微创介入放射学技术（如血管造影栓塞和动脉结扎）的出现，现在可以进行明确但保守的治疗，试图避免严重围产期出血患者进行子宫切除术。如果这些干预措施不足以控制出血，必须迅速决定进行子宫切除术。重组凝血因子 VIIa 是一种相对较新的治疗方法，可能对严重凝血功能障碍和难治性出血有用。
