akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2025.482akusherstvo-2649Research ArticleREVIEW ARTICLESНАУЧНЫЕ ОБЗОРЫManagement of coagulopathy related to major obstetric bleeding: narrative reviewЛечение коагулопатии, связанной с большим акушерским кровотечением: описательный обзорhttps://orcid.org/0000-0002-6953-3556Корреа-ПересЛ.Correa-PérezL.

Корреа-Перес Лилиана, магистр по биоэтике, магистр общественного здравоохранения

Scopus Author ID: 57202113479

6-25 ул. 12C, Богота, округ Колумбия

20-56 ул. 127, Богота 110911

Liliana Correa-Pérez, MD, PhD in Bioethics, Master's degree in Public Health

6-25 Str. 12C, Bogotá D.C. 111071

20-56 Str. 127, Bogotá 110911

https://orcid.org/0000-0003-1239-9947Олайя-ГарайС.Olaya-GarayS.

Олайя-Гарай Сандра

Scopus Author ID: 55293174800

ул. 9а. № 19-03, Манисалес 170001

Sandra Olaya-Garay, MD

9a Str. No. 19-03, Manizales 170001

https://orcid.org/0000-0001-8122-6180Мора-МартинесС.Mora-MartínezS.

Мора-Мартинес Сантьяго

Scopus Author ID:57217172045

ул. 9а. № 19-03, Манисалес 170001

15 Северная – 46 ул. 13, Армения 630008

Santiago Mora-Martínez, MD

9a Str. No. 19-03, Manizales 170001

15 North – 46 Str. 13, Armenia 630008

smora553910@cue.edu.coУниверситет Росарио; Педиатрическая клиника Colsanitas y MujerКолумбияUniversidad del Rosario; Clínica Pediátrica Colsanitas y MujerColombiaУниверситет МанисалесаКолумбияUniversidad de ManizalesColombiaУниверситет Манисалеса; Корпорация Universitaria Empresarial Александра фон ГумбольдтаРоссияUniversidad de Manizales; Corporación Universitaria Empresarial Alexander von HumboldtRussian Federation202519012026196914–922Copyright © Correa-Pérez L., Olaya-Garay S., Mora-Martínez S., 20262026Корреа-Перес Л., Олайя-Гарай С., Мора-Мартинес С.Correa-Pérez L., Olaya-Garay S., Mora-Martínez S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/2649

Obstetric bleeding represents one of the main causes of maternal mortality worldwide. Along with hypertensive disorders it accounts for over half of maternal mortality cases. The implementation of strategies such as the "code red", increased institutionalized deliveries, early transfusions, and early obstetric alert system has reduced mortality. Cases of massive bleeding require admission to the Intensive Care Unit as they can progress to coagulopathy. This narrative review focuses on medications intended for the advanced management of coagulopathy in this population.

Акушерские кровотечения представляют собой одну из основных причин материнской смертности во всем мире. Вместе с гипертензивными расстройствами они составляют более половины случаев материнской смертности. Внедрение стратегий, таких как «красный код», увеличение числа институциональных родов, ранние трансфузии и системы раннего предупреждения в акушерстве, привело к снижению смертности. Случаи массивного кровотечения требуют госпитализации в отделение интенсивной терапии, так как они могут усугубляться вплоть до развития коагулопатии. Настоящий описательный обзор фокусируется на лекарствах, предназначенных для более эффективного ведения коагулопатией в указанной группе лиц.

беременностьродыпослеродовое кровотечениекоагулопатияpregnancydeliverypostpartum hemorrhagecoagulopathyReferencesDouthard R.A., Martin I.K., Chapple-McGruder T. et al. U.S. maternal mortality within a global context: historical trends, current state, and future directions. J Womens Health (Larchmt). 2021;30(2):168–77. https://doi.org/10.1089/jwh.2020.8863.Douthard R.A., Martin I.K., Chapple-McGruder T. et al. U.S. maternal mortality within a global context: historical trends, current state, and future directions. J Womens Health (Larchmt). 2021;30(2):168–77. https://doi.org/10.1089/jwh.2020.8863.The WHO application of ICD-10 to deaths during pregnancy, childbirth, and the puerperium: ICD-MM. World Health Organization, 2013. 38 p. Available at: https://www.hsph.harvard.edu/wp-content/uploads/sites/2413/2014/05/Doris-Chou.pdf. [Accessed: 15.01.2024].The WHO application of ICD-10 to deaths during pregnancy, childbirth, and the puerperium: ICD-MM. World Health Organization, 2013. 38 p. Available at: https://www.hsph.harvard.edu/wp-content/uploads/sites/2413/2014/05/Doris-Chou.pdf. [Accessed: 15.01.2024].Trikha A., Singh P.M. Management of major obstetric haemorrhage. Indian J Anaesth. 2018;62(9):698–703. https://doi.org/10.4103/ija.IJA_448_18.Trikha A., Singh P.M. Management of major obstetric haemorrhage. Indian J Anaesth. 2018;62(9):698–703. https://doi.org/10.4103/ija.IJA_448_18.Dahlke J.D., Mendez-Figueroa H., Maggio L. et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol. 2015;213(1):76.e1–76.e10. https://doi.org/10.1016/j.ajog.2015.02.023.Dahlke J.D., Mendez-Figueroa H., Maggio L. et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol. 2015;213(1):76.e1–76.e10. https://doi.org/10.1016/j.ajog.2015.02.023.Vélez-Álvarez G.A., Agudelo-Jaramillo B., Gómez-Dávila J.G., Zuleta-Tobón J.J. Code Red: guide for the management of obstetric bleeding. Rev Colomb Obstet Ginecol. 2009;60(1):34–48. https://doi.org/10.18597/rcog.352.Vélez-Álvarez G.A., Agudelo-Jaramillo B., Gómez-Dávila J.G., Zuleta-Tobón J.J. Code Red: guide for the management of obstetric bleeding. Rev Colomb Obstet Ginecol. 2009;60(1):34–48. https://doi.org/10.18597/rcog.352.Robinson D., Basso M., Chan C. et al. Guideline No. 431: postpartum hemorrhage and hemorrhagic shock. J Obstet Gynaecol Can. 2022;44(12):1293–1310.e1. https://doi.org/10.1016/j.jogc.2022.10.002.Robinson D., Basso M., Chan C. et al. Guideline No. 431: postpartum hemorrhage and hemorrhagic shock. J Obstet Gynaecol Can. 2022;44(12):1293–1310.e1. https://doi.org/10.1016/j.jogc.2022.10.002.Shakur H., Elbourne D., Gülmezoglu M. et al. The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double blind placebo controlled trial. Trials. 2010;11:40. https://doi.org/10.1186/17456215-11-40.Shakur H., Elbourne D., Gülmezoglu M. et al. The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double blind placebo controlled trial. Trials. 2010;11:40. https://doi.org/10.1186/17456215-11-40.WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with postpartum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017;389(10084):2105–16. https://doi.org/10.1016/S0140-6736(17)30638-4.WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with postpartum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017;389(10084):2105–16. https://doi.org/10.1016/S0140-6736(17)30638-4.Muñoz M., Stensballe J., Ducloy-Bouthors A.S. et al. Patient blood management in obstetrics: prevention and treatment of postpartum haemorrhage. A NATA consensus statement. Blood Transfus. 2019;17(2):112–36. https://doi.org/10.2450/2019.0245-18.Muñoz M., Stensballe J., Ducloy-Bouthors A.S. et al. Patient blood management in obstetrics: prevention and treatment of postpartum haemorrhage. A NATA consensus statement. Blood Transfus. 2019;17(2):112–36. https://doi.org/10.2450/2019.0245-18.Reale S.C., Farber M.K. Point-of-care coagulation testing for obstetric hemorrhage: time for a theranostic approach? Int J Obstet Anesth. 2019;38:1–3. https://doi.org/10.1016/j.ijoa.2019.04.001.Reale S.C., Farber M.K. Point-of-care coagulation testing for obstetric hemorrhage: time for a theranostic approach? Int J Obstet Anesth. 2019;38:1–3. https://doi.org/10.1016/j.ijoa.2019.04.001.Abdul-Kadir R., McLintock C., Ducloy A.S. et al. Evaluation and management of postpartum hemorrhage: consensus from an international expert panel. Transfusion. 2014;54(7):1756–68. https://doi.org/10.1111/trf.12550.Abdul-Kadir R., McLintock C., Ducloy A.S. et al. Evaluation and management of postpartum hemorrhage: consensus from an international expert panel. Transfusion. 2014;54(7):1756–68. https://doi.org/10.1111/trf.12550.Bell S.F., Kitchen T., John M. et al. Designing and implementing an all Wales postpartum haemorrhage quality improvement project: OBS Cymru (the Obstetric Bleeding Strategy for Wales). BMJ Open Qual. 2020;9(2):e000854. https://doi.org/10.1136/bmjoq-2019-000854.Bell S.F., Kitchen T., John M. et al. Designing and implementing an all Wales postpartum haemorrhage quality improvement project: OBS Cymru (the Obstetric Bleeding Strategy for Wales). BMJ Open Qual. 2020;9(2):e000854. https://doi.org/10.1136/bmjoq-2019-000854.Collins P.W., Bell S.F., de Lloyd L., Collis R.E. Management of postpartum haemorrhage: from research into practice, a narrative review of the literature and the Cardiff experience. Int J Obstet Anesth. 2019;37:106– 17. https://doi.org/10.1016/j.ijoa.2018.08.008.Collins P.W., Bell S.F., de Lloyd L., Collis R.E. Management of postpartum haemorrhage: from research into practice, a narrative review of the literature and the Cardiff experience. Int J Obstet Anesth. 2019;37:106– 17. https://doi.org/10.1016/j.ijoa.2018.08.008.Muñoz M., Peña-Rosas J.P., Robinson S. et al. Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement. Transfus Med. 2018;28(1):22–39. https://doi.org/10.1111/tme.12443.Muñoz M., Peña-Rosas J.P., Robinson S. et al. Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement. Transfus Med. 2018;28(1):22–39. https://doi.org/10.1111/tme.12443.Franchini M., Liumbruno G.M. Implementation of a patient blood management programme in obstetrics: let's do it! Blood Transfus. 2019;17(2):87–8. https://doi.org/10.2450/2019.0269-18.Franchini M., Liumbruno G.M. Implementation of a patient blood management programme in obstetrics: let's do it! Blood Transfus. 2019;17(2):87–8. https://doi.org/10.2450/2019.0269-18.Katz D., Beilin Y. Disorders of coagulation in pregnancy. Br J Anaesth. 2015;115 Suppl 2:ii75–88. https://doi.org/10.1093/bja/aev374.Katz D., Beilin Y. Disorders of coagulation in pregnancy. Br J Anaesth. 2015;115 Suppl 2:ii75–88. https://doi.org/10.1093/bja/aev374.de Lange N.M., Lancé M.D., de Groot R. et al. Obstetric hemorrhage and coagulation: an update. Thromboelastography, thromboelastometry, and conventional coagulation tests in the diagnosis and prediction of postpartum hemorrhage. Obstet Gynecol Surv. 2012;67(7):426–35. https://doi.org/10.1097/OGX.0b013e3182605861.de Lange N.M., Lancé M.D., de Groot R. et al. Obstetric hemorrhage and coagulation: an update. Thromboelastography, thromboelastometry, and conventional coagulation tests in the diagnosis and prediction of postpartum hemorrhage. Obstet Gynecol Surv. 2012;67(7):426–35. https://doi.org/10.1097/OGX.0b013e3182605861.Nester T. Transfusion management of the obstetrical patient: a clinical casebook. Ed. T. Nester. Springer, USA. 2018. 246 р.Nester T. Transfusion management of the obstetrical patient: a clinical casebook. Ed. T. Nester. Springer, USA. 2018. 246 р.Collis R.E., Collins P.W. Haemostatic management of obstetric haemorrhage. Anaesthesia. 2015;70 Suppl 1:78–86, e27–8. https://doi.org/10.1111/anae.Collis R.E., Collins P.W. Haemostatic management of obstetric haemorrhage. Anaesthesia. 2015;70 Suppl 1:78–86, e27–8. https://doi.org/10.1111/anae.Cortet M., Deneux-Tharaux C., Dupont C. et al. Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial. Br J Anaesth. 2012;108(6):984–9. https://doi.org/10.1093/bja/aes096.Cortet M., Deneux-Tharaux C., Dupont C. et al. Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial. Br J Anaesth. 2012;108(6):984–9. https://doi.org/10.1093/bja/aes096.Charbit B., Mandelbrot L., Samain E. et al. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost. 2007;5(2):266–73. https://doi.org/10.1111/j.1538-7836.2007.02297.x.Charbit B., Mandelbrot L., Samain E. et al. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost. 2007;5(2):266–73. https://doi.org/10.1111/j.1538-7836.2007.02297.x.de Lloyd L., Bovington R., Kaye A. et al. Standard haemostatic tests following major obstetric haemorrhage. Int J Obstet Anesth. 2011;20(2):135–41. https://doi.org/10.1016/j.ijoa.2010.12.002.de Lloyd L., Bovington R., Kaye A. et al. Standard haemostatic tests following major obstetric haemorrhage. Int J Obstet Anesth. 2011;20(2):135–41. https://doi.org/10.1016/j.ijoa.2010.12.002.Wikkelsoe A.J., Afshari A., Stensballe J. et al. The FIB-PPH trial: fibrinogen concentrate as initial treatment for postpartum haemorrhage: study protocol for a randomised controlled trial. Trials. 2012;13:110. https://doi.org/10.1186/1745-6215-13-110.Wikkelsoe A.J., Afshari A., Stensballe J. et al. The FIB-PPH trial: fibrinogen concentrate as initial treatment for postpartum haemorrhage: study protocol for a randomised controlled trial. Trials. 2012;13:110. https://doi.org/10.1186/1745-6215-13-110.Ducloy-Bouthors A.S., Mignon A., Huissoud C. et al. Fibrinogen concentrate as a treatment for postpartum haemorrhage-induced coagulopathy: A study protocol for a randomised multicentre controlled trial. The fibrinogen in haemorrhage of DELivery (FIDEL) trial. Anaesth Crit Care Pain Med. 2016;35(4):293–8. https://doi.org/10.1016/j.accpm.2015.10.011.Ducloy-Bouthors A.S., Mignon A., Huissoud C. et al. Fibrinogen concentrate as a treatment for postpartum haemorrhage-induced coagulopathy: A study protocol for a randomised multicentre controlled trial. The fibrinogen in haemorrhage of DELivery (FIDEL) trial. Anaesth Crit Care Pain Med. 2016;35(4):293–8. https://doi.org/10.1016/j.accpm.2015.10.011.Ducloy-Bouthors A.S., Mercier F.J., Grouin J.M. et al.; FIDEL working group. Early and systematic administration of fibrinogen concentrate in postpartum haemorrhage following vaginal delivery: the FIDEL randomised controlled trial. BJOG. 2021;128(11):1814–23. https://doi.org/10.1111/1471-0528.16699.Ducloy-Bouthors A.S., Mercier F.J., Grouin J.M. et al.; FIDEL working group. Early and systematic administration of fibrinogen concentrate in postpartum haemorrhage following vaginal delivery: the FIDEL randomised controlled trial. BJOG. 2021;128(11):1814–23. https://doi.org/10.1111/1471-0528.16699.Mallaiah S., Barclay P., Harrod I. et al. Introduction of an algorithm for ROTEM-guided fibrinogen concentrate administration in major obstetric haemorrhage. Anaesthesia. 2015;70(2):166–75. https://doi.org/10.1111/anae.12859.Mallaiah S., Barclay P., Harrod I. et al. Introduction of an algorithm for ROTEM-guided fibrinogen concentrate administration in major obstetric haemorrhage. Anaesthesia. 2015;70(2):166–75. https://doi.org/10.1111/anae.12859.Collins P.W., Cannings-John R., Bruynseels D. et al. Viscoelastometryguided fresh frozen plasma infusion for postpartum haemorrhage: OBS2, an observational study. Br J Anaesth. 2017;119(3):422–34. https://doi.org/10.1093/bja/aex245.Collins P.W., Cannings-John R., Bruynseels D. et al. Viscoelastometryguided fresh frozen plasma infusion for postpartum haemorrhage: OBS2, an observational study. Br J Anaesth. 2017;119(3):422–34. https://doi.org/10.1093/bja/aex245.Collins P.W., Cannings-John R., Bruynseels D. et al. Viscoelastometric-guided early fibrinogen concentrate replacement during postpartum haemorrhage: OBS2, a double-blind randomized controlled trial. Br J Anaesth. 2017;119(3):411–21. https://doi.org/10.1093/bja/aex181.Collins P.W., Cannings-John R., Bruynseels D. et al. Viscoelastometric-guided early fibrinogen concentrate replacement during postpartum haemorrhage: OBS2, a double-blind randomized controlled trial. Br J Anaesth. 2017;119(3):411–21. https://doi.org/10.1093/bja/aex181.Guasch E., Alsina E., Díez J. et al. Postpartum hemorrhage: an observational study of 21,726 deliveries in 28 months. Rev Esp Anestesiol Reanim. 2009;56(3):139–46. (In Spanish). https://doi.org/10.1016/s0034-9356(09)70356-1.Guasch E., Alsina E., Díez J. et al. Postpartum hemorrhage: an observational study of 21,726 deliveries in 28 months. Rev Esp Anestesiol Reanim. 2009;56(3):139–46. (In Spanish). https://doi.org/10.1016/s0034-9356(09)70356-1.Belpiede A., Tinelli A., Crescini C. et al. Post-partum hemorrhage: can it be prevented by assisting the natural physiological process? Ital J Gynaecol Obstet. 2021;33(2):110–19. https://doi.org/10.36129/jog.33.02.05.Belpiede A., Tinelli A., Crescini C. et al. Post-partum hemorrhage: can it be prevented by assisting the natural physiological process? Ital J Gynaecol Obstet. 2021;33(2):110–19. https://doi.org/10.36129/jog.33.02.05.Saccone G., Nazzaro G., Miranda M. et al. Use of tranexamic acid at the time of delivery. Ital J Gynaecol Obstet. 2024;36(1):70–6. https://doi.org/10.36129/jog.2023.107.Saccone G., Nazzaro G., Miranda M. et al. Use of tranexamic acid at the time of delivery. Ital J Gynaecol Obstet. 2024;36(1):70–6. https://doi.org/10.36129/jog.2023.107.

The authors declare that there are no conflicts of interest present.