Protocol Based Blood Management in Major Obstetric Haemorrhage- A Case Series

Abstract

Major obstetric haemorrhage remains the leading cause of maternal mortality globally. Irrespective of the etiology of haemorrhage, rapid and efficient intervention using proactive standardised protocols should gain precedence in the management of major obstetric haemorrhage. As the available resources vary between institutions, protocol specific to each institution is important for timely intervention. This case series reports a few successfully managed cases of obstetric haemorrhage by the implementation of institution based Massive Transfusion Protocol (MTP). Two antenatally diagnosed patients with placenta percreta had elective hysterectomy with bladder repair. The massive haemorrhages in both these cases were managed efficiently with the use of MTP without any sequelae. Another case of atonic Postpartum Haemorrhage (PPH) which did not respond to first line management also was treated successfully with the prompt activation of protocol. A case of uterine rupture with haemorrhagic shock was managed with massive transfusion according to protocol and vasopressors and she survived with no major side effects. A case of traumatic PPH which presented with severe anaemia (Hb 4.6 gm/dL) could also be successfully resuscitated by the timely activation of MTP.

Understanding Transfusion Therapy in Obstetrics: Ensuring Maternal and Fetal Health

“…Transfusion therapy in obstetrics constitutes a critical element in the comprehensive management of maternal hemorrhage, a foremost cause of maternal mortality globally (1). Obstetric hemorrhage, often unforeseen and rapid in onset, poses substantial risks to both maternal and fetal health, necessitating immediate and effective interventions (2).…”

“…Future directions involve advancements in research exploring alternative therapies and hemostatic agents to reduce reliance on allogeneic blood products and enhance safety in transfusion practices (1). Transfusion therapy stands as a pivotal intervention in managing obstetric hemorrhage, preserving maternal stability, and optimizing fetal outcomes.…”