Gynaecological (non-pregnant) bleeding

We suggest that normovolaemic haemodilution should not be used as it does not reduce allogeneic transfusion. 2B

Cell salvage may reduce allogeneic transfusion in gynaecological (including oncological) surgery. B

We suggest using preoperative intravenous iron to reduce allogeneic transfusion requirements in anaemic gynaecological cancer patients receiving chemotherapy. 2B

We suggest using intravenous iron to correct preoperative anaemia in women with menorrhagia. 2B

Tranexamic acid may reduce perioperative bleeding in gynaecological cancer surgery. C

Obstetric bleeding

We recommend that peripartum haemorrhage (PPH) should be managed by a multidisciplinary team. 1C

We recommended the use of an escalating PPH management protocol including uterotonic drugs, surgical and/or endovascular interventions and procoagulant drugs. 1B

Risk awareness and early recognition of severe PPH are essential. C

We suggest that patients with known placenta accreta be treated by multidisciplinary care teams. 2C

Cell salvage is well tolerated in obstetric settings, provided that precautions are taken against rhesus isoimmunisation. C

We suggest that using perioperative cell salvage during caesarean section may decrease postoperative homologous transfusion and reduce hospital stay. 2B

Intravenous iron supplementation improves fatigue at 4, 8 and 12 weeks postpartum. B

We suggest assessing fibrinogen levels in parturients with bleeding, as levels less than 2g l-1 may identify those at risk of severe PPH. 2B

Dynamic platelet count decrease or a level less than 100x109 l-1 at the onset of labour, particularly if combined with plasma fibrinogen level less than 2.9 g l-1, may indicate an increased risk of PPH. C

At the beginning of labour aPTT and PT are of little predictive value for PPH. C

VHA can identify obstetric coagulopathy. B

We recommend against pre-emptive fibrinogen replacement; however, in ongoing PPH with hypofibrinogenaemia we recommend fibrinogen replacement. 1C

In severe PPH we suggest a VHA-guided intervention protocol. 2C

We suggest that tranexamic acid be considered before caesarean section and in cases of antepartum bleeding. 2B

We recommend the administration of tranexamic acid in PPH at a dose of 1 g intravenously (IV) as soon as possible, which can be repeated if bleeding continues. 1B