As you may know in the British news today, a young Jehovah's witness mum of 22 has died after childbirth.
What is the usual maortality rate if a patient is haemorraging & what non blood products are available in extreme circumstances?
P.S I am not being confrontational I am one of JW's and I am just trying to prepare for the backlash.

Hello. The article that I read did not get into detail as to the cause of the hemmorhaging. I am a student and NOT an expert but found a few things that could be useful. Carrying twins puts greater stress on the uterus and puts a woman at a greater risk for hemmorhage. There are several possible causes of hem. could have been uterus failed to contract (uterine atony) this would be treated with oxytocin, and if it continued to fail to contract (which stops the bleeding naturally) an emergency hysterectomy woud possibly be performed. Also, there is a treatment, Prostaglandin F that could contribute to stopping the hemm. I could not find any info regarding this tx and do not know if it contains blood products. Could anyone help me out on that? There are quite a few other interventions that could be utilized. It's easy to speculate and say what could have/should have happened but with out details it's hard to know the whole picture. If the complication was D.I.C. it is quite likely that blood or no blood she would not have survived. Hope this helps a bit? And please anyone correct me where I'm wrong

Thank you for your reply, as I am not in the medical field please could you explain what D.I.C means please?

Wikipedia says:-
Disseminated intravascular coagulation (DIC), also called consumptive coagulopathy, is a pathological process in the body where the blood starts to coagulate throughout the whole body. This depletes the body of its platelets and coagulation factors, and there is a paradoxically increased risk of hemorrhage. It occurs in critically ill patients, especially those with Gram-negative sepsis (particularly meningococcal sepsis) and acute promyelocytic leukemia.


There are a variety of causes of DIC, all usually causing the release of chemicals into the blood that instigates the coagulation.

* Sepsis, particularly with gram-negative bacteria.
* Obstetric complications (most common cause), with chemicals from the uterus being released into the blood, or from amniotic fluid embolisms, and eclampsia can be causes. Another obstetric condition which can cause DIC is abruptio placentae.
* Tissue trauma such as burns, accidents, surgery or shock.
* Liver disease
* Incompatible blood transfusion reactions or massive blood transfusion (more than the total circulatory volume)
* Cancers, or widespread tissue damage (e.g. burns), or hypersensitivity reactions all can produce the chemicals leading to a DIC.
* Acute promyelocytic leukemia
* Viral hemorrhagic fevers bring about their frank effects, paradoxically, by causing DIC.
* Envenomation by some species of venomous snakes, such as those belonging to the genus Echis (saw-scaled vipers).

I was taught, D.I.C= uncontrollable clotting in one area, and uncontrollable bleeding in another, just to simplify =)

This is from the University of Pisa, Italy, Bloodless Medicine Research website under Myelodysplastic Syndromes:

Novel treatments are being investigated for treating DIC; many of these experimental modalities target the excessive T[issue] F[actor] activity that characterizes DIC (Am J Hematol 1998 Sep;59(1):65-73)
Antithrombin III, antifibrinolytic agents, activated protein C, tissue factor pathway inhibitor, hirudin, or synthetic serine protease inhibitors. (Semin Thromb Hemost 1998;24(1):53-9)

Treatment for DIC

The underlying cause must be treated initially. Anticoagulants are only given when indicated (development of thrombotic renal complications) as patients with DIC are prone to bleeding. Platelets may be transfused if counts are very low, and fresh frozen plasma may be administered.

DIC results in lower fibrinogen (as it has all been converted to fibrin), and this can be tested for in the hospital lab. A more specific test is for "fibrin split products" (FSPs) or "fibrin degradation products" (FDPs) which are produced when fibrin undergoes degradation when blood clots are dissolved by fibrinolysis.

In some situations, infusion with antithrombin may be necessary. A new development is drotrecogin alfa (Xigris®), a recombinant activated protein C product. Activated Protein C (APC) deactivates clotting factors V and VIII, and the presumed mechanism of action of drotrecogin is the cessation of the intravascular coagulation. Due to its high cost, it is only used strictly on indication in intensive care patients.[1]

The prognosis for those with DIC, depending on its cause, is often grim...

__________________
Mr. Jan B. Wade
Blood Management Consultant
Enhance Outcomes - Control Cost
For Information Call - 360 296-1807
Email

Since the diagnosis of DIC has not been made it is best to stop the bleeding even before diagnosis. NovoSeven has been successfully used in this senario. Even balloon treatment can be used to save the patients life.

__________________
Jim Laws

Novel treatments are being investigated for treating DIC; many of these experimental modalities target the excessive T[issue] F[actor] activity that characterizes DIC. (Am J Hematol 1998 Sep;59(1):65-73)
Antithrombin III, antifibrinolytic agents, activated protein C, tissue factor pathway inhibitor, hirudin, or synthetic serine protease inhibitors. (Semin Thromb Hemost 1998:24(1):53-9)

Here are two of many articles that support the early use of NovoSeven in obstetric bleeding:

Minerva Anestesiol. 2006 Jun;72(6):389-93

Critical bleeding in pregnancy: a novel therapeutic approach to bleeding

Baudo F, Caimi TM, Mostarda G, de Cataldo F, Morra E.
Unit of Thrombosis and Hemostasis, Department of Hematology, Niguarda Hospital, Milan, Italy. francesco.baudo@ospedaleniguarda.it


AIM: In the developed countries the frequency of life threatening post-partum hemorrhages (PPH) is 1 in 1,000 deliveries with a risk of death of 1-2/100,000 deliveries. Hysterectomies for intractable bleeding are carried out in approximately 50% of the cases. The majority of PPH have obstetrical causes, most frequently atony of the uterus. Hereditary and acquired hemostatic defects are very rare. Guidelines of standard surgical and medical measures are available. In this paper we focus on the use of activated recombinant factor VII (rFVIIa) in PPH. METHODS: A computerized literature search was carried out in PubMed and Ovid for papers published between 2001 and 2005 in the English literature reporting on life-threatening PPH treated with rFVIIa after failure of conventional therapy, including hysterectomy. RESULTS: We identified 11 papers including 39 patients; in 18 of them the laboratory data were indicative for disseminated intravascular coagulation and in 24 hysterectomy was carried out. Controlled or reduced bleeding was reported in 38 out of 39 treated patients. CONCLUSIONS: The bleeding can occur in a series of events conductive to metabolic complications, hypoxia, disseminate intravascular coagulation, organ damage and multiorgan failure, progressively exhaustive. The therapeutic intervention must be instituted as early as possible before successive complications ensue. These preliminary reports in PPH after failure of conventional standard therapy suggest that rFVIIa is an active agent but should be administered as early as possible before the consequences of severe and intractable bleeding.



J Med Assoc Thai. 2007 May;90(5):977-81

Effectiveness of recombinant activated factor VII (rFVII a) for controlling intractable postpartum bleeding: report of two cases and literature review

Jirapinyo M, Manonai J, Herabutya Y, Chuncharunee S.
Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University Rama VI Rd, Bangkok 10400, Thailand. ramjy@mahidol.ac.th


BACKGROUND: Recombinant activated factor VII is used for the treatment in patients with inherited or acquired hemophilia with inhibitors and congenital factor VII deficiencies. OBJECTIVE: Using recombinant activated factor VII in primary postpartum hemorrhage. MATERIAL AND METHOD: Two cases of women who had postpartum hemorrhage and were treated with recombinant activated factor VII after all conventional treatment failed. RESULTS: The intractable hemorrhage stopped after treatment with recombinant activated factor VII CONCLUSION: The present report showed that massive postpartum hemorrhage that failed to all procedures was controlled successfully by recombinant activated factor VII.