The objective of this review was to evaluate and summarize the current literature on the unlicensed use of the novel agent recombinant
activated factor VII (
rFVIIa) in the management of major
postpartum hemorrhage. After a systematic electronic search without temporal limits on MEDLINE, EMBASE, OVID and SCOPUS, the bibliographic references of all retrieved studies and reviews were additionally assessed for further reports of clinical trials. Unpublished works were also identified by searching abstracts from the most eminent conferences on this topic. In total, there were 31 studies that fulfilled our inclusion criteria. These studies incorporated 118 cases of massive
postpartum hemorrhage treated with
rFVIIa. The median age of the patients was 31.4 years, and
cesarean section appeared to increase the risk of
postpartum hemorrhage. At a median dose of 71.6 mug/kg,
rFVIIa was reported to be effective in stopping or reducing
bleeding in nearly 90% of the reported cases. Based on the evidence from the literature, we give some recommendations on the use of
rFVIIa in massive
postpartum hemorrhage. Nevertheless, although these reports suggest the potential role of
rFVIIa in treating massive
postpartum hemorrhage refractory to standard
therapy, we advise particular caution in interpreting these results, as they are derived from few and uncontrolled studies. Further evidence is needed using well-designed clinical trials to better assess the optimal dose, the effectiveness, and the safety of
rFVIIa in such critical
bleeding conditions.