Hydroxyethyl starch use for patients with postpartum hemorrhage : a review of clinical effectiveness, safety, and guidelines

Primary postpartum hemorrhage (PPH) is defined as blood loss of e 500 mL within 24 hours after giving birth. PPH is associated with considerable morbidity, and is a leading cause of maternal mortality in Canada and worldwide. Approximately 4.8% of pregnant women in Canada experience PPH, and PPH res...

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Corporate Author: Canadian Agency for Drugs and Technologies in Health
Format: eBook
Language:English
Published: Ottawa (ON) Canadian Agency for Drugs and Technologies in Health 17 September 2014, 2014
Series:Rapid response report
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Online Access:
Collection: National Center for Biotechnology Information - Collection details see MPG.ReNa
Summary:Primary postpartum hemorrhage (PPH) is defined as blood loss of e 500 mL within 24 hours after giving birth. PPH is associated with considerable morbidity, and is a leading cause of maternal mortality in Canada and worldwide. Approximately 4.8% of pregnant women in Canada experience PPH, and PPH results in approximately 1.5 maternal deaths per 100,000 live births. Fluid resuscitation is an important component of managing patients with PPH. Crystalloids and colloids are intravenous fluids used to expand the volume within the circulatory system in situations of blood loss. Examples of crystalloids include normal saline (sodium chloride 0.9%), 5% dextrose in water, and Ringer's lactate. Colloids differ from crystalloids in that they contain insoluble molecules which act to preserve osmotic pressure within the blood, whereas crystalloids reduce osmotic pressure due to hemodilution. Examples of colloids include albumin, dextran, gelatin, and hydroxyethyl starch. Hydroxyethyl starch is a form of plant starch that has been partially hydrolyzed to extend the duration of action of the molecule. Although hydroxyethyl starch has been used for a number of years in patients requiring fluid resuscitation, hydroxyethyl starch appears to increase the risk of a number of adverse events including mortality, acute kidney injury, refractory pruritus, and hemorrhage relative to crystalloids and other colloids. However, these studies included patients undergoing cardiac surgery and patients admitted to intensive care. It is unclear whether these adverse events are increased in patients with PPH. The purpose of this Rapid Response report is to identify studies and clinical practice guidelines evaluating the clinical effectiveness, safety, and recommendations regarding the use of hydroxyethyl starch in patients with PPH.
Item Description:Title from PDF caption. - "CADTH rapid response service."
Physical Description:1 PDF file (9 pages) illustration