Department of Obstetrics and Gynecology, Inselspital University Hospital, Bern, Switzerland.
J Perinat Med. 2011 Oct 24;40(1):43-9. doi: 10.1515/JPM.2011.109.
To evaluate the effectiveness of human recombinant activated factor VII (rhFVIIa, NovoSeven) in avoiding hysterectomy postpartum in the management of severe postpartum hemorrhage (PPH).
We performed a prospective cohort study at our university tertiary care center. Patients with severe post partum hemorrhage (blood loss >2000 mL) and failed medical and uterus-preserving surgical management, were treated with intravenous bolus administration of rhVIIa. Main outcome measures were cessation of bleeding, postpartum hysterectomy and thromboembolic events.
In 20/22 patients included, PPH was caused primarily by uterine atony, including 7 (32%) with additional lower genital tract lesion; in two women, it was due to pathologic placentation (placenta increta, 9%). One case of amniotic fluid embolism and one woman with uterine inversion were included. Recombinant hFVIIa was successful in stopping the PPH and in preventing a hysterectomy in 20/22 women (91%). The remaining two patients with persistent bleeding despite rhFVIIa treatment, who underwent postpartum hysterectomy, had placenta increta. No thromboembolic event was noticed.
This study describes the largest single center series of rhFVIIa treatment for fertility preservation in severe postpartum hemorrhage published to date. Our data suggest that administration of rhFVIIa is effective in avoiding postpartum hysterectomy after conservative medical and surgical measures have failed. Although randomized studies are lacking, rhFVIIa should be considered as a second-line therapeutic option of life-threatening postpartal bleeding, in particular if preservation of fertility is warranted and hysterectomy is to be avoided.
评估人重组活化因子 VII（rhFVIIa，诺维血）在避免产后严重产后出血（PPH）行子宫切除术中的效果。
我们在我们大学的三级保健中心进行了一项前瞻性队列研究。对患有严重产后出血（出血量＞2000ml）且药物和保留子宫的手术治疗失败的患者，给予rhVIIa 静脉推注。主要结局指标为止血、产后子宫切除术和血栓栓塞事件。
在纳入的 22 例患者中，20 例（91%）PPH 主要由子宫收缩乏力引起，包括 7 例（32%）有额外的下生殖道损伤；在两名女性中，它是由于病理性胎盘植入（胎盘植入，9%）。有 1 例羊水栓塞和 1 例子宫内翻。重组 hFVIIa 成功地停止了 PPH，并在 22 例女性（91%）中预防了子宫切除术。其余 2 例尽管使用 rhFVIIa 治疗仍持续出血的患者，行产后子宫切除术，这些患者有胎盘植入。未发现血栓栓塞事件。
本研究描述了迄今为止发表的关于 rhFVIIa 治疗严重产后出血以保留生育力的最大单中心系列研究。我们的数据表明，在保守的药物和手术措施失败后，rhFVIIa 的给药可有效避免产后子宫切除术。尽管缺乏随机研究，但 rhFVIIa 应被视为危及生命的产后出血的二线治疗选择，特别是如果需要保留生育力且需要避免子宫切除术。
