[The Anesthetic Management of Postpartum Hemorrhage].

Abstract

Postpartum hemorrhage, classified as either primary or secondary, is a leading cause of maternal mortality worldwide and a common and potentially life-threatening obstetric complication. Successful management of this condition is largely dependent on early detection and timely, appropriate intervention. In assessing the risk of postpartum hemorrhage, factors such as placental abnormalities and hereditary coagulopathies must be considered. The administration of uterotonic agents may reduce the risk of severe hemorrhage, and surgical facilities should be equipped with hybrid operating rooms with angiographic capabilities. In cases of unexpected emergency postpartum hemorrhage, a multidisciplinary approach is essential, involving obstetricians, anesthesiologists, surgical teams, laboratory hematology staff, and interventional radiologists able to perform procedures such as arterial embolization. Effective communication and coordination within these teams are crucial for optimal patient outcomes. Pre-anesthetic preparation should take into account physiological, psychological, and pathological changes associated with pregnancy. The results of related studies indicate that postpartum hemorrhage within 24 hours is not significantly affected by the use of neuraxial anesthesia during vaginal delivery. However, general anesthesia has been shown to increase the risk of postpartum hemorrhage by 8.15 times compared to when regional anesthesia is used. The close monitoring of blood loss, clinical signs, fluid and blood transfusions, electrolyte balance, and acid-base status is essential to maintaining hemodynamic stability. Endotracheal intubation may be necessary, with postoperative extubation risks carefully assessed. Furthermore, clinicians should monitor for complications such as transfusion-related acute lung injury or circulatory overload. In severe cases, patients should be transferred to the intensive care unit for further management.