[Antenatal management for patients with increased risk of post-partum hemorrhage (excluding abnormal placentation)]

Abstract

Objectives: To describe management and screening for high-risk patients concerning post-partum hemorrhage (PPH) and antenatal management for severe anemia, thrombopenia, bleeding disorders and anticoagulant therapy.

Methods: Bibliographic search restricted to French and English languages using Medline database and recommendations of medical societies.

Results: The appropriate place for delivery should be chosen after multidisciplinary concertation based on level of risk (especially past-history of severe PPH and bleeding disorder) and easy access to blood products (Professional Consensus). Prevention for severe anemia is mainly based on oral iron supplementation (grade B). Explorations are required in case of thrombopenia<100Giga/L (grade C). Patients with bleeding disorder require the assistance of a physician skilled in hemostasis for perinatal management (grade C). Preventive anticoagulant therapy has no impact on PPH risk and perimedullar analgesia is usually authorized 12hours after last injection (grade C). Curative anticoagulant therapy slightly increases PPH risk and perimedullar analgesia is authorized only after 24hours since last injection (Professional Consensus).

Conclusion: Prenatal identification of high-risk patients concerning PPH implies multidisciplinary concertation to determine the most appropriate birthplace where technical and human resources are available.

Keywords: Anemia; Anticoagulant therapy; Anticoagulants; Anémie; Bleeding disorders; Coagulopathie; Hémorragie du post-partum; Immune thrombocytopenic purpura; Orientation; Post-partum hemorrhage; Prenatal management; Prise en charge anténatale; Purpura thrombopénique immunologique; Troubles de l’hémostase.