Management of Postpartum Hemorrhage: Transfusion of Blood Products [24OP]

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 133 Suppl 1; no. 1; p. 8
• Main Authors: Menzies, Anya V, Poljak, Dijana, Pearl, Michael Loran, Gossner, Gabrielle, Griffin, Todd R, Burke, William M
• Format: Journal Article
• Language: English
• Published: by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved 01.05.2019
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/01.AOG.0000559091.23971.8a

INTRODUCTION:Postpartum hemorrhage causes significant maternal morbidity and mortality. Coordinated care and adherence to standard protocol in these events may improve patient outcomes. Few studies of the obstetric population focus on appropriate transfusion of blood products. Studies in the trauma and anesthesia literature recommend a 1:1:1 transfusion protocol. Adherence to these recommendations among labor and delivery units nationwide remains unclear. METHODS:After IRB approval was obtained, we conducted a retrospective analysis examining all pregnant patients greater than 23 weeks gestation who delivered between 2011-2017 and received transfusion of at least 4 units of packed red blood cells (PRBCs) at our institution. Patients were identified by blood bank transfusion records. Data was collected regarding patient demographics, labor course, hemorrhage event and management, postpartum course, and associated complications. Each case was analyzed for adherence to a transfusion protocol. RESULTS:There were 23,964 deliveries during the study period. 90 (0.38%) patients who received at least four units PRBCs were identified. The median total EBL was 2800 ml (450ml-9,000ml). The median units transfused werePRBCs 4.0 (4-22), fresh frozen plasma 2.0 (0-17), platelets 0 (0-7). None of the patients received a transfusion of products in a 1:1:1 ratio. Of the 90 studied patients, 24 (26.7%) required admission to the intensive care unit. CONCLUSION:Obstetrical hemorrhage is a rare but serious event. From review of the data, adherence to standardized use of a transfusion protocol at this institution is rare. In order to diminish maternal mortality, utilization of a hemorrhage protocol with a transfusion ratio should be encouraged.