Introduction
Peripartum hemorrhage is a significant reason for maternal morbidity and mortality. An effective management plan requires several factors, such as a multidisciplinary, structured approach, with the early recognition that obstetric-related hemorrhage has the potential to rapidly turn life-threatening. Obstetric management and peripartum hemorrhage of certain patients as well as the approach to their management, is critical. PPH, or peripartum hemorrhage, is one of the leading causes of maternal mortality all around the world. This is even more common in countries that are low to middle-income. In recent years, there has been an increase in the number of cases of peripartum hemorrhage, even in countries that are considered to have high economic growth. Nevertheless, there are several treatment strategies for peripartum hemorrhage, along with multidisciplinary approaches such as those mentioned below.
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Surgery.
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Hysterectomy (surgical removal of the uterus).
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Blood transfusion (the process of transferring blood from a donor to a recipient to replace blood loss or improve blood conditions).
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Arterial ligation (a surgical procedure that involves tying or sealing off an artery to restrict blood flow to a specific area).
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Embolization (a medical technique where small particles or substances are introduced into blood vessels to block or reduce blood flow to a specific organ or area).
What Is Peripartum Hemorrhage?
Peripartum hemorrhage remains one of the main ground of maternal mortality worldwide. A key element of anaesthesiologists, as well as hemostatic management, is the expansion of a multidisciplinary routine operating technique that combines both surgical as well as medical along with hemostatic methods depending on the stringency of bleeding. The guideline emphasizes the significance of clinical as well as laboratory diagnostics of peripartum hemorrhage as early as it possibly can. This allows for early identification of reasons for bleeding and specific treatment. The guideline additionally comprises several evidence-based recommendations that are for the use of uterotonics, Tranexamic acid, as well as blood products such as those mentioned below.
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Factor concentrates.
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Fresh frozen plasma.
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Platelet concentrates.
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Packed red blood cells.
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Recombinant activated factor VII.
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Desmopressin.
In addition to the above-mentioned, certain recommendations for strategies to conserve blood, such as involving the use of cell salvage, permissive hypotension as well as transfusion triggers, are present. PPH, or peripartum hemorrhage, holds approximately one-quarter to around one-third of all patient deaths. It should be noted that all around the world, seven females pass away every hour due to peripartum hemorrhage. The most developing regions around the world account for the majority of patient deaths. There are several reports that do signify the growth of peripartum hemorrhage in already developed countries.
Why Is Anesthesia in Peripartum Hemorrhage Important?
As healthcare providers and healthcare professionals in the gynecology and obstetrics suite, anesthesiologists as well are repeatedly called upon in order to provide an exceptional and unique skill set along with their expertise in managing peripartum hemorrhage, if anticipated or not. The essential contribution of the anesthetic team does begin with the female patients who are at an elevated risk of peripartum hemorrhage to obstetric anesthesia, where a methodical plan for both critical or prepared delivery for such patients with a predicted complex delivery may be formulated. Maternal and female patient safety can additionally be greatly improved in case the comorbidities are identified at an early stage. The strategies for addressing peripartum hemorrhage and related issues are suggested and comprehended by the obstetric anesthesia team.
Active participation of the obstetric anesthesiology team is paramount in devising certain systematic strategies customized to each and every patient. It should be noted that the management of peripartum hemorrhage demands a very coordinated team and multidisciplinary effort and even then, it may not always be quite planned. The team of anesthesia and gynecologist must be prepared each and every time in order to provide suitable and accurate peripartum hemorrhage-related anesthetic management along with advanced cardiovascular system support. The involvement of the anesthesia professionals must not strictly be limited to the instantaneous peripartum period but must additionally extend to the postpartum period, where adequate anesthetic or analgesic plans may enhance maternal safety as well as maternal recovery.
What Are the Anesthesia Management of Unexpected Peripartum Hemorrhage?
After the anesthesia team has been notified of the patient’s condition of peripartum hemorrhage by the obstetrics team, the available options for anesthesia are majorly governed by the professionals in anesthesia care. Other factors that are to be kept in mind by the professionals of anesthesia and gynecologist team are the amount of blood that has been perceived to have been lost during labor, the presumptive etiological factor of the onset of peripartum hemorrhage, the proposed surgical and medical management of the patient's peripartum condition, and also the patient's hemodynamic stability.
What Are the Recovery Plans in Peripartum Hemorrhage?
Anesthetic care of the patient with peripartum hemorrhage must extend beyond the decisiveness of bleeding. The anesthesiologist team should decide, in convergence with the obstetrician and gynecology professionals, the level of peripartum care the patient must require, as well as if that planned care may be delivered in the PACU or post-operative care unit in the labor and delivery unit, which is a high-risk unit or in an intensive care unit. Medical requirements that may necessitate transferring the female patient to the intensive care unit should also be kept in mind. The anesthetic care of the female patient with peripartum hemorrhage develops from the antenatal course through into the postpartum period. Optimal management of peripartum hemorrhage occurs when all the nurses, obstetricians as well as anesthesiologists recognize quite early on the possibility of unreasonable bleeding.
Conclusion
Anesthesia is required in order to assist in the therapy of peripartum hemorrhage when manual removal of the placenta or cleaning out of the uterine cavity is necessary. The choice between general anesthesia or regional anesthesia does depend upon several factors such as existing epidural, hypovolaemia, airway, and tradition. It should be noted that practice varies extremely between delivery hospitals, such as those with large setups and those preferring regional anesthesia. The healthcare professional of the obstetrics, as well as the anesthesia groups, must be well aware and finely experienced in understanding, diagnosing, and treating peripartum hemorrhage.
