In addition it may not be practically obtainable due to time constraints in cases of active bleeding. Unresponsive PPH requires laparotomy with subsequent ligation of uterine and ovarian vessels or with hysterectomy. Providers who understand the

aetiology and management of postpartum bleeding may make the difference between life and death for women experiencing PPH. In women with IBD, bleeding selleck inhibitor during pregnancy and postpartum can be prevented or treated with adequate haemostatic cover. Specific haemostatic concentrates are required for women with severe bleeding disorders (Table 1). In women with mild bleeding disorders, antifibrinolytics (mainly TA) and in selected cases desmopressin Olaparib (1-deamino-8-D-arginine vasopressin, DDAVP), can be used effectively avoiding the need for blood products. In addition, in healthy women and those with undiagnosed defects of haemostasis, antenatal and postpartum bleeding, especially those induced by placental abruption with

its associated hyper-fibrinolysis, can be treated with antifibrinolytics. These are considered as the most important category of non-specific haemostatic drugs because they can improve deficient haemostasis by delaying local and systemic fibrinolysis. The main non specific and specific haemostatic drugs useful during pregnancy and postpartum of women with or without inherited bleeding disorders are summarized in (Table 3). Desmopressin (DDAVP): mild VWF and FVIII deficiencies or mild platelet defects Tranexamic acid, (TA) and DDAVP are the most common haemostatic drugs currently used in clinical practice to prevent and treat antenatal and postpartum bleeding in both healthy women and those with IBD. However, most recommendations available are based on a few studies mainly retrospective in design, or the personal experience of experts. Antifibrinolytic agents are used for treatment or prevention of bleeding in two clinical settings: to block systemic fibrinolysis or to inhibit local MCE fibrinolysis at sites of vascular injury. Three main drugs are available for use: Epsilon-Amino Caproic Acid (EACA),

Tranexamic Acid (TA) and Aprotinin (APR). APR is the most potent antifibrinolytic agent but its use has recently been limited because an increased mortality rate was reported in several clinical trials [42]. In addition, it was withdrawn from the market in 2008 in some European countries because of the possibility of Creutzfeldt-Jakob disease transmission as APR products are extracted from bovine lungs. TA is more potent than EACA and is now available in most countries and the most widely used antifibrinolytic in clinical practice. The use of TA during pregnancy, delivery and postpartum was evaluated in a recent systematic review [39]. TA was shown to reduce blood loss during elective caesarean section (Fig. 2) and vaginal delivery in prospective studies [39, 43].