Predicting the need for blood transfusion requirement in postpartum hemorrhage

Attali, Emmanuel; Many, Ariel; Kern, Guy; Reicher, Lee; Kahana, Adiel; Shemer, Asaf; Kagan, Georgy; Gamzu, Ronni; Yogev, Yariv; Zakar, Liat

doi:10.1080/14767058.2021.1937992

Cited by 6 publications

(7 citation statements)

References 20 publications

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“…Delayed recognition of and response to acute bleeding is a leading cause of maternal mortality and 'near misses'. 774 Peaks and developments in shock index (heart rate divided by SBP [775][776][777][778][779] together with venous lactate [780][781][782] and ionised calcium 783 ) may predict further bleeding and severity of PPH. A protocol-based intervention grants an early access to blood products.…”

Section: Evidence Summarymentioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

101

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BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

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Section: Evidence Summarymentioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

101

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“…27,28 Antepartum hemoglobin, shock index (heart rate divided by systolic blood pressure), lower immediate postpartum hemoglobin, fibrinogen, and lactate levels are associated with more severe PPH and transfusion requirements. [31][32][33] The role of point-of-care viscoelastic testing such as thromboelastograpy (TEG) or rotational thromboelastography (ROTEM) is a developing area. 34,35 Management of PPH is directed at correcting underlying etiologies (e.g., uterotonics, repair and packing, tamponade, surgical techniques) and at the hemorrhage itself (e.g., tranexamic acid, consideration of transfusion and/or fibrinogen replacement).…”

Section: Discussion: Pph General Considerationsmentioning

confidence: 99%

“…The main causes of PPH can be divided into the mnemonic of the four T’s: tone (e.g., uterine atony, which is most common), trauma (e.g., cervical or vaginal lacerations), tissue (e.g., retained products, placenta accreta spectrum), and thrombin (e.g., inherited or acquired coagulation abnormalities) 27,28 . Antepartum hemoglobin, shock index (heart rate divided by systolic blood pressure), lower immediate postpartum hemoglobin, fibrinogen, and lactate levels are associated with more severe PPH and transfusion requirements 31–33 . The role of point‐of‐care viscoelastic testing such as thromboelastograpy (TEG) or rotational thromboelastography (ROTEM) is a developing area 34,35 .…”

Section: Vwd Case and Discussion Of Obstetric Bleedingmentioning

confidence: 99%

JTH in Clinic ‐ Obstetric bleeding: VWD and other inherited bleeding disorders

Johnsen

MacKinnon²

2022

Journal of Thrombosis and Haemostasis

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Individuals with inherited bleeding disorders (IBDs) have higher bleeding risk during pregnancy, childbirth, and the postpartum period. Clinical management requires recognition of the IBD as high risk for postpartum hemorrhage and a personalized multidisciplinary approach that includes the patient in decision making. When the fetus is known or at risk to inherit a bleeding disorder, fetal and neonatal bleeding risk also need to be considered. In pregnant IBD patients, it is common for providers to need to make decisions in the absence of high level of certainty evidence. We here present the case of a pregnant von Willebrand disease patient that reached multiple decision points where there is currently clinical ambiguity due to a lack of high level of certainty evidence. For each stage of her care, from diagnosis to the postpartum period, we discuss current literature and describe our approach. This is followed by a brief overview of considerations in other IBDs and pregnancy.

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“…Blood tests are useful to identify causes such as anaemia and infection that are driving a maternal tachycardia. A retrospective cohort study found the combination of a low haemoglobin, high lactate and high shock index >1 [heart rate (beats/min) divided by systolic blood pressure (mmHg)] predicted the need of requiring a blood transfusion in postpartum haemorrhage with a positive predictive value of 86% [8 ▪▪ ]. Conversely a normal haemoglobin, normal lactate and shock index <1 could be reassuring that an urgent transfusion is not required.…”

Section: Step 2: Basic (Most Patients)mentioning

confidence: 99%

Postpartum maternal tachycardia – diagnostic pitfalls!

Mathur,

Tohani,

Patil

et al. 2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Maternal tachycardia is a common sign with a multitude of causes. We attempt to look at the most common sinister ones in the postpartum period. Recent findings Current guidelines differ in the definition of maternal tachycardia. It has been associated with adverse outcomes such as increased length of stay as well as higher mortality if there is underlying peripartum cardiomyopathy. Some recent studies look at common investigations and how these apply to peripartum women, such as ECG markers of arrhythmogenesis, reference ranges for PCT and echocardiogram findings during pregnancy prior to diagnosis of peripartum cardiomyopathy. Summary Physiological changes make it difficult to interpret maternal tachycardia and thus how best to manage it. We propose the idea of a three-step approach for the assessment of patients, aiming to identify causes including tachyarrhythmias, obstetric haemorrhage, sepsis, venous thromboembolism and peripartum cardiomyopathy. The first step ‘BEDSIDE’ applies to all patients looking at observations, history and examination. The second step ‘BASIC’, applies to most patients and covers ECG and basic blood tests. The final step ‘EXTRA’ assesses the need for further investigations including additional blood tests and imaging. By using this model, clinicians and healthcare professionals should be able to rationalise the need for more invasive investigations whilst maintain good high-quality care.

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Predicting the need for blood transfusion requirement in postpartum hemorrhage

Cited by 6 publications

References 20 publications

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

JTH in Clinic ‐ Obstetric bleeding: VWD and other inherited bleeding disorders

Postpartum maternal tachycardia – diagnostic pitfalls!

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