Obstetrical haemorrhage – the management algorithm
1 I Klinika Anestezjologii i Intensywnej Terapii Warszawskiego Uniwersytetu Medycznego.
Kierownik: dr hab. n. med. Tomasz Łazowski
2 I Katedra i Klinika Położnictwa i Ginekologii Warszawskiego Uniwersytetu Medycznego. Kierownik: prof. dr hab. n. med. Mirosław Wielgoś
Adres do korespondencji: Dr n. med. Elżbieta Nowacka, I Klinika Anestezjologii i Intensywnej Terapii Warszawskiego Uniwersytetu Medycznego, ul. Lindleya 4, 02‑005 Warszawa, tel.: 22 502 17 24, 22 502 14 24, tel. kom.: 505 106 120, e‑mail: mops2506@interia.pl
Praca finansowana ze środków własnych
Pediatr Med rodz Vol 8 Numer 1, p. 23-32
ABSTRACT

Obstetrical haemorrhage still remains one of the most common causes of death among pregnant women and women in labour. Almost 88% of these women die within the first 4 hours of its onset. Knowing the mechanisms that regulate hemostasis of the woman in labour at the molecular, immunological, hormonal, neurological level and the role and function of the uteroplacental unit has a huge impact on the further therapeutic decisions in case of obstetrical haemorrhage. There are a number of various definitions concerning obstetrical haemorrhage which proves how difficult it is to recognize and diagnose this condition. Taking under consideration the haemodynamic changes, the systemic consequences and the need of making specific therapeutical decisions it seems necessary to include in the definition the dynamics of the blood loss in the specific time unit: cumulated blood loss of 150 ml/min or 1.5 ml/kg of body weight per minute and a 50% loss of circulating blood volume in 3 hours. The prognosis of the haemorrhage depends on many different elements, including: rapid diagnosis, notification and implement of the management therapeutic algorithm and interdisciplinary co‑work of various teams taking part in the diagnostic‑therapeutic process. It is crucial that there is an effective, simultaneous cooperation among the experienced anaesthesiology team, ob‑gyn team, the operating theatre team, diagnostic‑laboratory teams and the regional blood donation agencies. Coordinating work of that many people, that are often spread within the organizational structures of the hospital on different floors or buildings, is excessively challenging. On the other hand, establishing the management algorithm that takes into account the order and the way of notifying as well as implementing certain procedures in individual organizational structures has a huge, direct impact on patient’s survival and the quality of life. Most of the management procedures for the severe obstetrical haemorrhage, such as resuscitation, monitoring, bleeding control, should be performed simultaneously.

Keywords: obstetrics, haemorrhage, definition, management algorithm, interdisciplinary co‑work