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Primary postpartum hemorrhage, generally defined as estimated blood loss of 1 L or more in the first 24 postpartum hours, is a major cause of morbidity and mortality in otherwise healthy women. Despite lack of evidence of efficacy and safety, and despite the high cost (estimated at US$9000 to $18,000 per treatment course), recombinant activated factor VII (rFVIIa) is being used increasingly in Europe to treat postpartum hemorrhage as part of comprehensive therapy often including surgery. European investigators report 97 cases of primary hemorrhage in which rFVIIa was used between 2000 and 2004.
Fully 62% of the women had uncomplicated pregnancies, and cesarean delivery was performed in 49%. Uterine atony was the cause of bleeding in more tha…