Successful Use of Recombinant Factor VIIa for Treatment of Severe Postpartum Hemorrhage

1postpartum blood loss still results in severe maternal morbidity, 2 such as hypovolemic shock, renal failure, adult respiratory distress syndrome, hepatic failure, and disseminated intravascular coagulopathy. 3 Early, effective, and preferably noninvasive treatment is therefore essential. Primary postpartum hemorrhage is initially managed by restoration of blood volume, administration of oxytocin and prostaglandins, and the correction of coagulation. 2 If these initial conservative therapeutic measures do not control the bleeding, more drastic and invasive interventions such as bilateral artery ligation, angiography with selective embolization, or, as a last resort, hysterectomy can be performed. Recombinant factor VIIa (rFVIIa; NovoSeven) is a safe and effective drug for the treatment of bleeding episodes in patients with inherited or acquired hemophilia A or B and antibodies to the relevant coagulation factor (VIII or IX, respectively). Recently rFVIIa has been used successfully in patients with congenital or acquired platelet disorders, thrombocytopenia, and severe von Willebrand’s disease (type 3). The use of rFVIIa in patients with severe bleeding without known coagulation factor deficiencies or (preexisting) bleeding disorders has been reported in several case reports. 4-7 We describe a case of severe postpartum hemorrhage due to uterine atony resistant to conservative treatment in which use of a single dose of rFVIIa successfully controlled the bleeding and thereby obviated invasive procedures.