Current strategies for the diagnosis and management of postpartum hemorrhage: a focused review of four Cochrane Systematic Reviews from 2024 and 2025

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia Pub Date : 2025-05-26 DOI:10.1016/j.ijoa.2025.104692

Y. Binyamin , S. Orbach-Zinger , M. Heesen

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引用次数: 0

Abstract

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality worldwide, particularly in low-resource settings. Despite international initiatives, significant variability persists in how PPH is diagnosed and managed. This integrative review synthesizes findings from four recent Cochrane systematic reviews published in 2024 and 2025, aiming to inform clinical practice and highlight research gaps. The included reviews examined: (1) diagnostic accuracy of tools during vaginal birth, (2) implementation strategies for WHO guidelines, (3) transfusion of blood and blood products, and (4) intraoperative cell salvage during cesarean delivery.

Calibrated blood loss tools combined with clinical observation demonstrated superior performance compared to visual estimation, with pooled sensitivity of 93% and specificity of 95%. Multicomponent strategies modestly improved adherence to WHO-recommended practices, yet had limited impact on maternal mortality and ICU admissions. Evidence regarding transfusion thresholds, fibrinogen concentrate, and cryoprecipitate was of low certainty and inconclusive. Intraoperative cell salvage showed potential benefits, including a reduction in total blood loss (mean difference –113.6 mL) and a modest increase in postpartum hemoglobin (mean difference +6.14 g/L), although the overall quality of evidence remains low.

This review underscores the value of objective measurement tools and structured implementation efforts in improving PPH care. However, transfusion and salvage practices require further validation in high-quality randomized trials. Greater attention is needed to address context-specific challenges, particularly in settings with limited resources.

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产后出血诊断和治疗的当前策略：对2024年和2025年四篇Cochrane系统评价的重点回顾

产后出血（PPH）仍然是全世界孕产妇死亡的主要原因，特别是在资源匮乏的地区。尽管采取了国际行动，但PPH的诊断和管理方式仍然存在显著差异。本综合综述综合了Cochrane在2024年和2025年发表的四篇系统综述的研究结果，旨在为临床实践提供信息并突出研究空白。纳入的综述检查了：(1)阴道分娩时工具的诊断准确性，(2)世卫组织指南的实施策略，(3)血液和血液制品的输血，以及(4)剖宫产术中细胞抢救。与目测相比，经校准的失血量工具结合临床观察显示出更优越的性能，总灵敏度为93%，特异性为95%。多成分策略略微提高了对世卫组织推荐做法的依从性，但对孕产妇死亡率和ICU入院率的影响有限。关于输血阈值、纤维蛋白原浓缩物和低温沉淀的证据是低确定性和不确定的。术中细胞抢救显示出潜在的益处，包括总失血量的减少（平均差值-113.6 mL）和产后血红蛋白的适度增加（平均差值+6.14 g/L），尽管证据的总体质量仍然很低。本综述强调了客观测量工具和结构化实施工作在改善PPH护理方面的价值。然而，输血和抢救实践需要在高质量的随机试验中进一步验证。需要更加注意解决具体情况下的挑战，特别是在资源有限的情况下。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of obstetric anesthesia 医学-妇产科学

CiteScore

4.70

自引率

7.10%

发文量

285

审稿时长

58 days

期刊介绍： The International Journal of Obstetric Anesthesia is the only journal publishing original articles devoted exclusively to obstetric anesthesia and bringing together all three of its principal components; anesthesia care for operative delivery and the perioperative period, pain relief in labour and care of the critically ill obstetric patient. • Original research (both clinical and laboratory), short reports and case reports will be considered. • The journal also publishes invited review articles and debates on topical and controversial subjects in the area of obstetric anesthesia. • Articles on related topics such as perinatal physiology and pharmacology and all subjects of importance to obstetric anaesthetists/anesthesiologists are also welcome. The journal is peer-reviewed by international experts. Scholarship is stressed to include the focus on discovery, application of knowledge across fields, and informing the medical community. Through the peer-review process, we hope to attest to the quality of scholarships and guide the Journal to extend and transform knowledge in this important and expanding area.