Use of Recombinant Activated Factor VII: Pakistani Experience of Managing Massive Obstetric Haemorrhage.

Background: Massive obstetric haemorrhage is still a prime cause of maternal mortality and morbidity. Remarkable efficacy of off-label use of Recombinant Activated Factor VII (rFVIIa) has been reported in cases of postpartum haemorrhage (PPH) refractory to conventional measures. This study aims to determine the clinical efficacy of rFVIIa for patients with massive obstetric haemorrhage.

Methodology: This was a retrospective cross-sectional comparative study of patients with PPH who received rFVIIa during their treatment at the Department of Obstetrics and Gynaecology from November 2009 to April 2018. The data was collected by chart review on a specified form. The age, parity, cause of bleeding, primary treatment measures followed by rFVIIa treatment were recorded. Time since bleeding to administration of rFVIIa was also recorded. The response of rFVIIa in terms of required transfusion volume, need for ICU/ventilator support, fertility preservation and maternal outcome were also compared and analyzed.

Results: In this study, mean age of patients was 33 ±4 years and uterine atony was the most frequent (>50%) cause of Post-partum Haemorrhage (PPH). Out of 12 patients, 50% received injection rFVIIa who within 6 hours were labelled as early group while 50% received it after 6 hours were labelled as late group. Statistically significant difference was observed in terms of fertility preservation, transfusion requirement and duration of ICU/ hospital stay in early and late groups. Although improved maternal outcome was noted following early rFVIIa administration, but it was not found statistically significant between the two groups.

Conclusion: Massive PPH not responding to conventional measures can be managed with early administration of rFVIIa which is an effective haemostatic agent.

Key Message: Massive PPH not responding to conventional measures can be managed with rFVIIa which also has a significant role in preserving fertility if used before hysterectomy.