From the Guidelines
Intractable hemorrhage refers to severe, uncontrolled bleeding that does not respond to standard treatments or interventions, posing a significant threat to a patient's life and requiring immediate and aggressive management. In the context of obstetric care, intractable hemorrhage is a life-threatening condition that may arise from complications such as placenta accreta spectrum, as discussed in the American Journal of Obstetrics and Gynecology 1. This condition is characterized by excessive blood loss, often defined as estimated blood loss of 1,500 mL or greater, which can lead to hypofibrinogenemia, a biomarker predictive of severe postpartum hemorrhage 1. The management of intractable hemorrhage involves a multidisciplinary approach, including surgical interventions, interventional radiology, and transfusion management. Key concepts in managing intractable hemorrhage include treating the patient based on clinical presentation, keeping the patient warm, rapidly transfusing packed red blood cells, fresh frozen plasma, and platelets in a fixed ratio, and avoiding acidosis 1.
Some procedural strategies worthy of consideration in cases of intractable hemorrhage include:
- Hypogastric artery ligation, although its efficacy has not been proved and it may be ineffective due to collateral circulation 1
- Interventional radiology to embolize the hypogastric arteries, which can be useful when there is no single source of bleeding that can be identified at surgery 1
- Pelvic pressure packing, which can be highly effective for patient stabilization and product replacement when experiencing acute uncontrolled hemorrhage 1
- Aortic compression or clamping, which is likely best reserved for experienced surgical consultants or heroic measures given the potential risk of vascular-related complications 1
The persistent nature of intractable hemorrhage can lead to significant morbidity, mortality, and reduced quality of life, emphasizing the need for prompt and effective management. Patients with intractable hemorrhage often require comprehensive care that addresses both the physical consequences of bleeding and its emotional impact, potentially including psychological support and lifestyle modifications alongside medical treatments.
From the Research
Definition of Intractable Hemorrhage
There are no research papers to assist in answering this question as the provided studies focus on intractable headaches, not intractable hemorrhage.
Intractable Headache
- Intractable headache is often used interchangeably with refractory headache to describe persistent headache that is difficult to treat or fails to respond to standard and/or aggressive treatment modalities 2, 3.
- A universal and graded classification scheme of intractability is needed to advance clinical and basic research in this population of patients 2.
- Intractable chronic headaches are a major challenge for both patients and healthcare professionals, and implantable electrical neuromodulators have been used increasingly for intractable primary and secondary headache disorders 4.
- The study of migraine has yielded many benefits for headache patients, but little research has been performed on refractory migraine (RM) headache, a term often used interchangeably with intractable migraine 3.
- Occipital nerve stimulation (ONS) has been used to treat intractable chronic cluster headache, offering a safe and effective option for some patients 5, 6.