Role of recombinant factor VIIa in the clinical management of severe postpartum hemorrhage: consensus among European experts

Figures & data

Figure 1. Summary of country-specific recommendations and guidelines on the use of rFVIIa in the management of sPPH.

Figure 2. Questions discussed by the Steering Committee during the face-to-face meeting. All participants reviewed the final statements offline after the meeting.

Table 1. The recommendations on the timing of rFVIIa use in sPPH during specified clinical scenarios.

Scenario	Recommended clinical step 1	Recommended clinical step 2	Recommended clinical step 3
Scenario 1: following vaginal delivery	First-line noninvasive and invasive measures^a	Consider rFVIIa	Laparotomy or uterine embolization
Scenario 2: during a C-section	First-line surgical measures^b	Consider rFVIIa	Uterine artery embolization or hysterectomy
Scenario 3: following C-section	If a patient is in the ICU or PACU and laparotomy has been closed, but with apparent severe bleeding, consider rFVIIa (eventually in combination with uterine artery embolization)	Re-laparotomy^c	N/A
Scenario 4: in a peripheral birthing unit resource setting	When considering transfer to a larger center from a smaller obstetric unit with limited resources, consider rFVIIa^d during transfer-set up to stabilize the patient and decrease risk of bleeding deterioration	N/A	N/A
Scenario 5: during or after hysterectomy	Consider rFVIIa in combination with other standard measures, if continual severe bleeding occurs and hemostasis is difficult	N/A	N/A

Abbreviations: C-section, cesarean section; CV, cardiovascular; IV, intravenous; rFVIIa, recombinant factor VII a; TXA, tranexamic acid.

Note that these scenarios are following a diagnosis of sPPH, and after administration of first-line therapy, including uterotonics and TXA.

^a First-line noninvasive and invasive measures including uterotonics, TXA, IV fluid, fibrinogen, laceration suturing, curettage, and uterine tamponade.

^b First-line surgical measures including uterine compression sutures, vessel ligation, and uterine tamponade.

^c In cases of persistent non-severe bleeding with significant hemoglobin decrease and/or CV instability, emergency revision laparotomy is performed.

^d Administration should not delay the patient’s transfer.

Data availability statement

No new data were created or analyzed during this study. Data sharing is not applicable to this article.