Postpartale Hämorrhagie

Die postpartale Hämorrhagie ist gemäß WHO-Definition [1] ein Blutverlust von ≥ 500 ml innerhalb von 24 Stunden nach der Geburt. Sie betrifft ca. 1–3% aller Entbindungen, und ihr Management ist einer der wichtigsten Indikatoren für die maternale Gesundheit eines Landes [2] [3] [4]. Die Identifikation von Risikofaktoren und das effektive Management postpartaler Hämorrhagien sind entscheidend für die Reduktion der maternalen Morbidität und Mortalität.

Schlüsselwörter

Geburtshilfe - postpartale Blutung - postpartale Hämorrhagie - Plazentationsstörungen - Uterustamponade - Oxytocin - Uteruskompressionsnaht

Publication History

Article published online:
11 December 2024

• Literatur

• 1 WHO. WHO Guidelines, Approved by the Guidelines Review Commitee. In: WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva: World Health Organization; 2012
• 2 Greene RA, McKernan J, Manning E. et al. Major obstetric haemorrhage: Incidence, management and quality of care in Irish maternity units. Eur J Obstet Gynecol Reprod Biol 2021; 257: 114-120
• 3 Reale SC, Easter SR, Xu X. et al. Trends in Postpartum Hemorrhage in the United States From 2010 to 2014. Anesth Analg 2020; 130: e119-e122
• 4 Sheldon WR, Blum J, Vogel JP. et al. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014; 121 (Suppl. 1) 5-13
• 5 Haeri S, Dildy 3rd GA. Maternal mortality from hemorrhage. Semin Perinatol 2012; 36: 48-55
• 6 Al-Zirqi I, Vangen S, Forsen L. et al. Prevalence and risk factors of severe obstetric haemorrhage. BJOG 2008; 115: 1265-1272
• 7 Evensen A, Anderson JM, Fontaine P. Postpartum Hemorrhage: Prevention and Treatment. Am Fam Physician 2017; 95: 442-449
• 8 Stones RW, Paterson CM, Saunders NJ. Risk factors for major obstetric haemorrhage. Eur J Obstet Gynecol Reprod Biol 1993; 48: 15-18
• 9 Booker W, Moroz L. Abnormal placentation. Semin Perinatol 2019; 43: 51-59
• 10 Morlando M, Collins S. Placenta Accreta Spectrum Disorders: Challenges, Risks, and Management Strategies. Int J Womens Health 2020; 12: 1033-1045
• 11 Rath W. [Postpartum Haemorrhage (PPH): “too little is done too late”!]. Z Geburtshilfe Neonatol 2011; 215: 177-181
• 12 Bienstock JL, Eke AC, Hueppchen NA. Postpartum Hemorrhage. N Engl J Med 2021; 384: 1635-1645
• 13 Gill P, Patel A, Van Hook JW. Uterine Atony. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023
• 14 Toppenberg KS, Block jr WA. Uterine rupture: what family physicians need to know. Am Fam Physician 2002; 66: 823-828
• 15 Dimitrova D, Kästner AL, Kästner AN. et al. Risk factors and outcomes associated with type of uterine rupture. Arch Gynecol Obstet 2022; 306: 1967-1977
• 16 Bloomfield V, Rogers S, Leyland N. Placenta accreta spectrum. CMAJ 2020; 192: E980
• 17 Cui C, Ma S, Qiao R. Prenatal Plasma Fibrinogen Level Predicts Postpartum Hemorrhage of Patients With HELLP Syndrome. Clin Appl Thromb Hemost 2020; 26: 1076029619894057
• 18 Parry Smith WR, Papadopoulou A, Thomas E. et al. Uterotonic agents for first-line treatment of postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev 2020; 2020 (11) CD012754
• 19 Gimpl G, Fahrenholz F. The oxytocin receptor system: structure, func on, and regulation. Physiol Rev 2001; 81: 629-683
• 20 Della Corte L, Saccone G, Locci M. et al. Tranexamic acid for treatment of primary postpartum hemorrhage after vaginal delivery: a systematic review and meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 2020; 33: 869-874
• 21 Ng W, Jerath A, Wąsowicz M. Tranexamic acid: a clinical review. Anaesthesiol Intensive Ther 2015; 47: 339-350
• 22 Roberts I, Brenner A, Shakur-S ll H. Tranexamic acid for bleeding: Much more than a treatment for postpartum hemorrhage. Am J Obstet Gynecol MFM 2023; 5: 100722
• 23 Langer B, Boudier E, Haberstich R. et al. [Obstetrical management in the event of persistent or worsening postpartum hemorrhage despite initial measures]. J Gynecol Obstet Biol Reprod (Paris) 2004; 33: 4S73-4S79
• 24 Hösli I, Büchel J. Stellenwert von Kontraktionsmitteln bei der postpartalen Hämorrhagie. Gynäkologe 2019; 52: 408-415
• 25 Grönvall M, Tikkanen M, Tallberg E. et al. Use of Bakri balloon tamponade in the treatment of postpartum hemorrhage: a series of 50 cases from a tertiary teaching hospital. Acta Obstet Gynecol Scand 2013; 92: 433-438
• 26 Dueckelmann AM, Hinkson L, Nonnenmacher A. et al. Uterine packing with chitosan-covered gauze compared to balloon tamponade for managing postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol 2019; 240: 151-155
• 27 Millner R, Lockhart AS, Marr R. Chitosan arrests bleeding in major hepatic injuries with clotting dysfunction: an in vivo experimental study in a model of hepatic injury in the presence of moderate systemic heparinisation. Ann R Coll Surg Engl 2010; 92: 559-561
• 28 Carles G, Dabiri C, McHirgui A. et al. Uses of chitosan for treating different forms of serious obstetrics hemorrhages. J Gynecol Obstet Hum Reprod 2017; 46: 693-695
• 29 Cho Y, Rizvi C, Uppal T. et al. Ultrasonographic visualization of balloon placement for uterine tamponade in massive primary postpartum hemorrhage. Ultrasound Obstet Gynecol 2008; 32: 711-713
• 30 Al Riyami N, Hui D, Herer E. et al. Uterine compression sutures as an effective treatment for postpartum hemorrhage: case series. AJP Rep 2011; 1: 47-52
• 31 Morel O, Malartic C, Muhlstein J. et al. Pelvic arterial ligations for severe post-partum hemorrhage. Indications and techniques. J Visc Surg 2011; 148: e95-e102
• 32 Westhoff G, Cotier AM, Tolosa JE. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. Cochrane Database Syst Rev 2013; (10) CD001808