Hémorragie du post-partum : actualités dans la prise en charge transfusionnelle

Post-partum haemorrhage is the first cause of maternal death in France. In addition to the treatment of the cause, its treatment consists in the association of procoagulant drugs and blood transfusion. At risk situations requiring blood transfusion are well identified. However, they are not found in one third of the actually transfused patients. Therefore, for all deliveries, the medical team should be prepared to face a post-partum haemorrhage and to transfuse. As post-partum haemorrhage onset is most frequently acute, it is rare to be able to base the transfusion decision on biological parameters such as haemoglobin concentration and / or coagulation tests. The recently defined policy of early use of fresh frozen plasma in order to better control the coagulopathy frequently associated with a large haemorrhage has not been established in obstetrical situations. However, it is recommended to apply it in large volume post-partum haemorrhage, with a fresh frozen plasma/red blood cells concentrate ratio between 1/1 and 1/2. The post-partum haemorrhage treatment may benefit from the use of drugs, the most frequently used being antifibrinolytics, such as tranexemic acid, which help to reduce the magnitude of post-partum haemorrhage. Conversely, activated factor VII use should be restricted to situations where all other conventional treatments failed, as a last attempt to avoid hysterectomy.