[Inter-hospital transfer for severe postpartum hemorrhage]

Abstract

Objectives: To elaborate guidelines for inter-hospital transfer for severe postpartum hemorrhage.

Materials and methods: Bibliographic search in Medline and Cochrane Database by PubMed.

Results: Severe postpartum hemorrhage sometimes needs inter-hospital transfer for arterial embolization or admission in intensive care unit. Validation of this transfer needs multidisciplinary decision, including obstetricians, anesthesiologist-intensivists of primary and tertiary center and prehospital medical team. If bleeding is too important or in case of uncontrolled hemorrhagic shock, inter-hospital transfer may be dangerous and local surgical hemostasis should be preferred. In such situation, prehospital medical team should stay on scene for help especially in small institutions where medical and paramedical resources are sometimes insufficient. In case of inter-hospital transportation, organ failure should be controlled and blood transfusion, if needed, should be initiated before. The patient should be transferred to a multidisciplinary center (surgery, anesthesiology and ICU, interventional radiologist, blood bank).

Conclusion: Inter-hospital transfer for severe postpartum hemorrhage is possible under certain conditions including continuation of blood transfusion and organ failure correction.

Keywords: Arterial embolization; Choc hémorragique; Embolisation artérielle; Hemorrhagic shock; Hémorragie du post-partum; Inter-hospital transfer; Postpartum hemorrhage; Transport inter-hospitalier.