How is thrombosis treated in postpartum hemorrhage (PPH)?

Updated: Jan 02, 2018
  • Author: Maame Yaa A B Yiadom, MD, MPH; Chief Editor: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE  more...
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Answer

Thrombosis

Evaluate the CBC and coagulation study results for evidence of clotting disorders. Providing blood products will be necessary if the bleeding is profuse or initial laboratory results show hemoglobin drop >10% from the patient's prior value or from the midpoint of the normal range with continued bleeding.

For anemia, transfuse type-specific blood (or O- blood if unable to wait). Using blood warmers that permit rapid infusion is highly recommended as long as this does not delay transfusion.

For thrombocytopenia, particularly if platelets are less than 50,000, consider transfusing a pack of platelets.

Fresh frozen plasma (FFP) may also be necessary in the setting of a coagulopathy (prolonged PT or PTT or INR >1.3). In the event of massive hemorrhage, plasma transfusion should be initiated with the replacement of red blood cells to avoid a dilutional coagulopathy by adding back a proportional amount of clotting factors. [24]

If transfusing more than 6 units of pRBCs occurs or is anticipated, give 4 units of FFP, 1 unit of platelets, and 1 unit of cryoprecipitate to avoid a transfusion-related dilutional coagulopathy. The effects of any anticoagulant medications that the patient may have on board should be reversed (aspirin with platelets, low molecular weight heparin [LMWH] or heparin with protamine, warfarin with vitamin K or FFP).

Also see the American College of Obstetricians and Gynecologists for guidelines on the treatment of postpartum hemorrhage. [15]


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