Clinical Analysis of Postpartum Hemorrhage Requiring Massive Transfusions at a Tertiary Center

Abstract

Background:The reports on massive transfusions (MTs) in obstetrics have recently been an increasing trend. We aimed to define the clinical features, risk factors, main causes, and outcomes of MTs due to severe postpartum hemorrhage (PPH) and the frequency trends over the past 10 years.Methods:We retrospectively analyzed the data of 3552 PPH patients who were at ≥28 weeks of gestation in the Obstetric Department of Peking University First Hospital from January 2006 to February 2015. The clinical records of patients receiving MT with ≥5 units (approximately 1000 ml) of red blood cells within 24 h of giving birth were included. The Pearson's Chi-square and Fisher's exact tests were used to compare the frequency distributions among the categorical variables of the clinical features.Results:One-hundred six women were identified with MT over the 10-year period. The MT percentage was stable between the first 5-year group (2006–2010) and the second 5-year group (2011–2015) (2.5‰ vs. 2.7‰, χ2 = 154.85, P = 0.25). Although uterine atony remained the main cause of MT, there was a rising trend for placental abnormalities (especially placenta accreta) in the second 5-year group compared with the first 5-year group (34% vs. 23%, χ2 = 188.26, P = 0.03). Twenty-four (23%) women underwent hysterectomy, and among all the causes of PPH, placenta accreta had the highest hysterectomy rate of 70% (17/24). No maternal death was observed.Conclusions:There was a rising trend for placental abnormalities underlying the stable incidence of MT in the PPH cases. Placenta accreta accounted for the highest risk of hysterectomy. It is reasonable to have appropriate blood transfusion backup for high-risk patients, especially those with placenta accreta.

Prevalence, related factors and maternal outcomes of primary postpartum haemorrhage in governmental hospitals in Kabul-Afghanistan

“…During the last 3 years, the mentioned hospitals have had about 75,000 births per year, which the highest birth rate was nested into Malalai Zijenton Hospital and the lowest birth rate was nested into the 102 bed Khair Khana hospital, 26,500 deliveries per year and 13,439 deliveries per year, respectively. The number of cesarean sections in these Hospitals accounts for 15 The population of this study consisted of all patients who delivered between August 2018 and October 2018, during the study period, and they were hospitalized in mentioned hospitals at the time of the study. The inclusion criteria included women who delivered in these four governmental hospitals or at home, and had primary PPH after normal vaginal delivery or cesarean section, within 24 h after birth.…”

“…Some diseases have association with PPH including blood transfusion, renal failure, coagulation deficiencies and are also associated with long-term morbidities, including anemia, hysterectomy. Moreover, with other surgical procedures to reduce blood flow to the uterus and their subsequent consequences, infertility has to be considered as a consequence of PPH, although it is difficult to quantify their burden [12,14,15].…”

Incidence, trends and risk factors for obstetric massive blood transfusion in China from 2012 to 2019: an observational study

“…10 However, only two small studies focused on obstetric MBT in China. 14 15 . One study concluded that the incidence of MBT in relation to PPH was stable (25-27 per 10 000 maternities) during 2006-2015.…”

Efficacy of Electroacupuncture Combined with Tropisetron in Treating Carboprost Tromethamine-Induced Nausea and Vomiting during Cesarean Section under Lumbar Anesthesia

“…According to statistics, maternal postpartum hemorrhage is >400 mL in 24.2% of cases [2]. Many reasons are reported to contribute to maternal postpartum hemorrhage, among which one of the main reasons is uterine atony [3]. Therefore, a series of measures are needed in clinic to enhance uterine contractility in pregnant women to reduce their perinatal risk.…”