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Anesthesia for the patient with peripartum hemorrhage

Authors
Jill M Mhyre, MD
Faiza A Khan, MD
Section Editor
David L Hepner, MD
Deputy Editor
Marianna Crowley, MD

INTRODUCTION

Peripartum hemorrhage is a major cause of maternal morbidity and mortality. Effective management requires a multidisciplinary, structured approach, with recognition that obstetric hemorrhage can rapidly become life threatening. This topic will discuss the anesthetic management of patients with peripartum hemorrhage or conditions that increase the risk of such hemorrhage.

Obstetric management of these patients and the approach to the management of postpartum hemorrhage (PPH) are discussed in detail separately. (See "Overview of postpartum hemorrhage" and "Management of postpartum hemorrhage at vaginal delivery" and "Management of postpartum hemorrhage at cesarean delivery" and "Placental abruption: Management" and "Management of placenta previa" and "Velamentous umbilical cord insertion and vasa previa" and "Uterine rupture after previous cesarean delivery" and "Peripartum hysterectomy for management of hemorrhage".)

PREANESTHESIA EVALUATION

Antenatal anesthesia consultation should be arranged for patients at high risk of peripartum hemorrhage and those for whom blood product preparation or transfusion may be complicated. (See "Overview of postpartum hemorrhage", section on 'Management of risk'.)

All obstetric patients should be evaluated for potential difficulty with airway management to create a plan for safe airway management in case general anesthesia is necessary. (See "Airway management of the pregnant patient at delivery", section on 'Identify patients with a difficult airway'.)

In addition to the usual medical and prenatal history, and anesthesia-directed physical examination, the following considerations should be addressed antenatally whenever time permits.

                             

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Literature review current through: Nov 2016. | This topic last updated: Tue Dec 06 00:00:00 GMT+00:00 2016.
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References
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  1. Bonnet MP, Deneux-Tharaux C, Bouvier-Colle MH. Critical care and transfusion management in maternal deaths from postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol 2011; 158:183.
  2. US Government Publishing Office. Electronic Code of Federal Regulations, section 606.151: Compatibility testing. http://www.ecfr.gov/cgi-bin/text-idx?SID=8f45b64ad21296576a284a6b1d0477e8&mc=true&node=pt21.7.606&rgn=div5#se21.7.606_1151 (Accessed on October 13, 2016).
  3. Green L, Knight M, Seeney F, et al. The haematological features and transfusion management of women who required massive transfusion for major obstetric haemorrhage in the UK: a population based study. Br J Haematol 2016; 172:616.
  4. Main EK, Goffman D, Scavone BM, et al. National Partnership for Maternal Safety: Consensus Bundle on Obstetric Hemorrhage. Obstet Gynecol 2015; 126:155.
  5. Shields LE, Wiesner S, Fulton J, Pelletreau B. Comprehensive maternal hemorrhage protocols reduce the use of blood products and improve patient safety. Am J Obstet Gynecol 2015; 212:272.
  6. Shields LE, Smalarz K, Reffigee L, et al. Comprehensive maternal hemorrhage protocols improve patient safety and reduce utilization of blood products. Am J Obstet Gynecol 2011; 205:368.e1.
  7. Chandraharan E, Arulkumaran S. Acute tocolysis. Curr Opin Obstet Gynecol 2005; 17:151.
  8. Peng AT, Gorman RS, Shulman SM, et al. Intravenous nitroglycerin for uterine relaxation in the postpartum patient with retained placenta. Anesthesiology 1989; 71:172.
  9. Hong RW, Greenfield ML, Polley LS. Nitroglycerin for uterine inversion in the absence of placental fragments. Anesth Analg 2006; 103:511.
  10. Yoo KY, Lee JC, Yoon MH, et al. The effects of volatile anesthetics on spontaneous contractility of isolated human pregnant uterine muscle: a comparison among sevoflurane, desflurane, isoflurane, and halothane. Anesth Analg 2006; 103:443.
  11. Tikkanen M, Paavonen J, Loukovaara M, Stefanovic V. Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta Obstet Gynecol Scand 2011; 90:1140.
  12. Pri-Paz S, Fuchs KM, Gaddipati S, et al. Comparison between emergent and elective delivery in women with placenta accreta. J Matern Fetal Neonatal Med 2013; 26:1007.
  13. Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. BJOG 2009; 116:648.
  14. O'Brien KL, Uhl L. How do we manage blood product support in the massively hemorrhaging obstetric patient? Transfusion 2016; 56:2165.
  15. Nagy CJ, Wheeler AS, Archer TL. Acute normovolemic hemodilution, intraoperative cell salvage and PulseCO hemodynamic monitoring in a Jehovah's Witness with placenta percreta. Int J Obstet Anesth 2008; 17:159.
  16. Lilker SJ, Meyer RA, Downey KN, Macarthur AJ. Anesthetic considerations for placenta accreta. Int J Obstet Anesth 2011; 20:288.
  17. Chestnut DH, Dewan DM, Redick LF, et al. Anesthetic management for obstetric hysterectomy: a multi-institutional study. Anesthesiology 1989; 70:607.
  18. Weiniger CF, Einav S, Deutsch L, et al. Outcomes of prospectively-collected consecutive cases of antenatal-suspected placenta accreta. Int J Obstet Anesth 2013; 22:273.
  19. Weiniger CF, Elram T, Ginosar Y, et al. Anaesthetic management of placenta accreta: use of a pre-operative high and low suspicion classification. Anaesthesia 2005; 60:1079.
  20. Nguyen-Lu N, Carvalho JC, Kingdom J, et al. Mode of anesthesia and clinical outcomes of patients undergoing Cesarean delivery for invasive placentation: a retrospective cohort study of 50 consecutive cases. Can J Anaesth 2016; 63:1233.
  21. Jeffrey A, Clark V. The anaesthetic management of caesarean section in the interventional radiology suite. Curr Opin Anaesthesiol 2011; 24:439.
  22. Clark A, Farber MK, Sviggum H, Camann W. Cesarean delivery in the hybrid operating suite: a promising new location for high-risk obstetric procedures. Anesth Analg 2013; 117:1187.
  23. Sadashivaiah J, Wilson R, Thein A, et al. Role of prophylactic uterine artery balloon catheters in the management of women with suspected placenta accreta. Int J Obstet Anesth 2011; 20:282.