Critical bleeding in pregnancy: a novel therapeutic approach to bleeding

Critical post-partum hemorrhage (PPH) occurs in 1/1,000 deliveries; hysterectomy 1/2,000; risk of death 1-2/100,000. The majority of the PPH have obstetrical causes, most frequently atony of the uterus. Hereditary and acquired hemostatic defects are very rare. The therapeutic intervention, to control the bleeding and its consequences, should be as early as possible. Guidelines of standard surgical and medical measures are available. rFVIIa has been successfully used in hemophilic patients with inhibitors and in critical bleeding of different causes. Preliminary anecdotal reports of its use in PPH after failure of conventional standard therapy suggest that rFVIIa should be administered as early as possible before the consequences of severe and intractable bleeding set in.