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Practice Clinical updates

Diagnosis and management of postpartum haemorrhage

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3875 (Published 27 September 2017) Cite this as: BMJ 2017;358:j3875
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Infographic available

A visual summary of suggested approaches for the management of primary and secondary postpartum haemorrahage

Re: Diagnosis and management of postpartum haemorrhage

Dear Sir or Madam:

A new hypothesis in the management of post-partum haemorrhage

Chandraharan and Krishna are to be congratulated on their very clear Clinic Update on the management of post-partum haemorrhage (PPH) (1).

Our therapeutic options for uterine atony (the principal cause of PPH) fall into just three types of intervention; hyperstimulation of the myometrium, correcting clotting disturbances, and the application of direct pressure. But given that the myometrium, in many cases of PPH, is exhausted, might there be some mileage in ‘myometrial resuscitation’?

Glucose is the principal fuel for myometrium activity. If the myometrium is exhausted of its glycogen reserve, and glucose uptake from the circulation compromised by general exhaustion, it would not seem unexpected that flogging the myometrium with ever more potent stimulatory drugs is likely to fail. Without fuel (glucose) the myometrium just cannot respond.

A brief search of the literature yielded just one paper mentioning (briefly) the use of glucose in PPH (2). We also found references to glucose therapy during acute myocardial ischaemia (sometimes enhanced with potassium and insulin to facilitate cellular glucose uptake), but nothing in the current obstetric literature. It may be that glucose supplementation may have a role not just in treating uterine atony, but perhaps too in its prevention. We would be interested in the views of your readers.

Miriam Barclay ST1 LAS, Obstetrics and Gynaecology, Colchester Hospital
Chris Barclay, Locum GP, Aldeburgh, Suffolk

1 – Diagnosis and management of postpartum haemorhage. Chandraharan
E, Krishna A. BMJ 2017;358:494-495
2 - The Principles of Treatment of Post-Partum Haemorrhage. Hunter W. Postgraduate Med J 1937 Nov;13(145):419-422. Accessed at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2476739/?page=1

Competing interests: No competing interests

03 October 2017
Miriam S Barclay
ST1LAS Obstetrics and Gynaecology
Christopher Barclay
Colchester General Hospital