Interest of Recombinant factor VIIa in the Management of Postpartum Hemorrhage

Abstract

Introduction : Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and morbidity in our country. The role of hemostatic treatments, particularly recombinant activated factor VII (rFVIIa), in combating coagulopathy occurring during the course of PPH has been highlighted in the literature.

Objective : To evaluate the efficacy and benefit/risk ratio of recombinant factor VIIa in the treatment of PPH.

Methods : This is a descriptive retrospective study including all parturients who received rFVIIa at the Ibn Jazzar Maternity Unit in Kairouan for PPH between January 1, 2021, and December 31, 2024.

Results : 15 patients were included. The mean age was 31 ± 5.96 years. The main risk factors for PPH were multiparity, overdistention, prolonged labor, and infection. The mean time to PPH diagnosis was 48 minutes. The most common cause of PPH was uterine atony. The mean time to rFVIIa administration was 6 hours 40 minutes. The average dose used was 78.8 ± 9.24 µg/kg. Five patients received a single dose, 8 patients received a seconde injection, and 2 patients required 3 doses. After rFVIIa administration, normalization of coagulation parameters was observed in 8 patients.

Conclusion : rFVIIa is not a first-line treatment but may be used as a single, repeatable dose if needed.

Keywords:

Postpartum hemorrhage, disseminated intravascular coagulation, recombinant activated factor VII

References

Arurkumaran S ,Tamizian O. The surgical management of post-partum haemorrhage. Best practice and Research Clinical Obstet and Gyneacol 2012;16(1):81-98.

Mayo A, Misgav M, Kluger Y et al. Recombinant activated factor VII (Novoseven™): addition to replacement therapy in acute, uncontrolled and life-threatening bleeding. Vox Sang 2014;87:34-40.

Dutton RP, Hess JR, Scalea TM. Recombinant factor VIIa for control of hemorrhage:

early experience in critically ill trauma patients. J Clin Anesth 2013;15:184-188.

Franchini M, Franchi M, Bergamini V et al. The use of recombinant activated FVII in postpartum hemorrhage. Clin Obstet Gynecol 2010;53:219–27.

AFSSAPS. Protocole thérapeutique temporaire pour le NOVOSEVEN lors du syndrome hémorragique en obstétrique.

Alfirevic Z, Elbourne D, Pavord S, et al. Use of recombinant activated factor VII in primary postpartum hemorrhage: the northern European registry 2000–2004. Obstet Gynecol 2017;110:1270–1278.

Barillari G, Frigo MG, Casarotto M, et al. Use of recombinant activated factor VII in severe post-partum haemorrhage: Data from the Italian Registry. A multicentric observational retrospective study. Thromb Res 2009;124(6):e41-7.

Hossain N, Soomro N et al. Use of recombinant factor VIIa for massive postpartum haemorrhage: case series and review of the literature. J Pak Med Assoc 2015;55:512–5.

Rapon C, Roger-Christoph S, Bonnet Mp, et al.Utilisation du facteur VII active dans les hémorragies du post-partum (HPP) : registre français« OFFHO », période 2005–2007. Ann Fr Anesth Reanim 2008;27S:R345.

10. Sergent F , Resch B, Verspyck E, et al. Intractable postpartum haemorrhages: where is the place of vascular ligations, emergency peripartum hysterectomy or arterial embolization? Gynecol Obstet Fertil, 2004.32(4):p.320-9.

Bouma LS, Bolte AC, Van Geijn HC. Use of recombinant activated factor VII in massive postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol 2008;137(2):172–7.

Ahonen J, Jokela R. Recombinant Factor VIIa for life-threatening post partum haemorrhage. Br J Anaesth 2015;94:592-595.

Ahonen J, Jokela R, Korttila K. An open non-randomized study of recombinant activated factor VII in major postpartum haemorrhage. Acta Anaesthesiol Scand 2017;51:929–36.

Moscardo F, Perez F, De La Rubia J, et al. Successful treatment of severe intra-abdominal bleeding associated withdisseminated intravascular coagulation using recombinant activated factor VII. Br J Haematol 2011;114(1):174-176.

Boehlen F, Morales MA, Fontana P, et al. Prolonged treatment of massive postpartum haemorrhage with recombinant factor VIIa: Case report and review of literature. Bjog 2004;11(3):284-287