| Situation: PPH presentations progress in severity and estimated blood loss (EBL) | OB/GYNs’ Treatment Strategy | Frequency/Variation Among OB/GYNs | Question # and Salient Facets | |
| Vaginal delivery; PPH secondary to uterine atony; EBL = 1 liter | Uterine massage; continue oxytocin; give IV volume replacement | Vast majority (96%) | Q #23 | |
| NEXT STEP: Administer Methergine® 0.2 mg intramuscularly | Large majority (73%) | Q #24 | ||
| Vaginal delivery; PPH secondary to uterine atony; all uterotonics administered; PPH persists; EBL=1.5 liters | Bakri balloon placement Other interventions | Majority (62%) 38% | Q #26 Bakri balloon available at 61% of OB/GYNs’ institutions | |
| As PPH presentations progress in severity, treatment strategies begin to diverge and variations in OB/GYNs’ approaches to management begin to emerge; clear majority responses are no longer obvious. ↓ | ||||
| Vaginal delivery; PPH secondary to uterine atony; all uterotonics administered; PPH persists; EBL = 1.5 liters; Patient desires future fertility | Interventional radiology for embolization rFVIIa Too risky | 47% 34% 17% | Q #27 Question posed with assumption that interventional radiology for embolization and rFVIIa are both available to OB/GYN | |
| Vaginal delivery; PPH secondary to uterine atony; massage, compression, and all uterotonics administered; PPH persists; EBL = 2 liters; hemodynamic instability | Bakri balloon placement Other interventions Consultation with HEM | 51% 43% 4% | Q #28 Indication of trigger for hematology consult | |
| Vaginal delivery; PPH secondary to uterine atony; massage, compression, and all uterotonics administered; PPH persists; EBL = 2 liters; hemodynamic instability; Determination that blook product replacement is necessary | Blood Product Replacement Management Strategy: 4 Units PRBC: 1 Unit FFP Other replacement ratios | 57% 43% | Q #29 Notable differences in OB/GYNs’ responses | |
| Empirical Transfusion of Platelets | Subsequent to platelet count After 4 units FFP | 36% 29% | Q #32 Huge variance in OB/GYNs’ responses | |
| Vaginal delivery; PPH secondary to uterine atony; massage, compression, and all uterotonics administered; EBL ≥ 2 liters; evidence of significant hemodynamic instability; patient transfused (6 units PRBC, 4 units FFP, 1 unit platelets) | Hysterectomy Other surgical interventions rFVIIa | 42% 49% 9% | Q #33 Suggests that this may be the trigger for potential use of NovoSeven® in refractory PPH if OB/GYN is familiar with rFVIIa (NOTE: 44% and 43% of OB/GYNs are unfamiliar or only slightly familiar with rFVIIa) | |