Women Receiving Massive Transfusion Due to Postpartum Hemorrhage: A Comparison Over Time Between 2 Nationwide Cohort Studies

Ramler, Paul I.; Akker, Thomas van den; Henriquez, Dacia D. C. A.; Zwart, Joost J.; Roosmalen, Jos van; Lith, J. M. M. van; Bom, J. van der; Paul, Ian M.

doi:10.1097/01.aoa.0000661340.97850.4e

Cited by 2 publications

(4 citation statements)

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“…In this cross-sectional study, about 745 women underwent cesarean section with the prevalence of 10.1% blood transfusion whereas the overall risk regarding cesarean section was 19.6%, which is more prevalent than the 0.63% to 12.2% reported in similar studies [13,14]. The higher prevalence of blood transfusion reported in the present study might be caused by various parameters such as pelvic disproportion, placenta previa, prolong labor, hypertensive disorders, and placental abruption in pregnancy.…”

Section: Discussionmentioning

confidence: 64%

Pattern of Blood Transfusion among Women Undergoing Caesarean Section in a Tertiary Health Care Centre

Habiba¹,

Bhattani²,

Wazir³

et al. 2021

PJMHS

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Background: Cesarean section delivery causes major risk factors in terms of intraoperative performance and blood loss while blood transfusion is a promising factor in emergency care in case of blood unavailability. Women undergoing cesarean section routinely require blood cross-matching. Aim: The present study aimed to evaluate the pattern of blood transfusion among women who underwent c/section at the tertiary care center. Materials and Methods: This cross-sectional study was conducted on 745 pregnant women who underwent cesarean section at Obstetrics & Gynaecology department of Quaid-e-Azam International Hospital Islamabad and PAF hospital Masroor, Karachi for duration of six months from January 2021 to June 2021. The demographic details, incidence of cesarean section, blood transfusion indications and types were recorded. Antenatal intraoperative and pre-operative details were also noted. Complications regarding blood transfusion were analyzed using multivariable analysis and EPI-statistical software v 3.5.3. Results: Of the total 745 cesarean sections, the prevalence of blood transfusion was 10.1%. About 75 women transfused 216 units of blood with packed cells tailed by Fresh Frozen Plasma (FFP). The prevalence of emergency cesarean section was 61 (81.3%) while general anesthesia was utilized in 27 (44.3%) cases. Fetal distress and placenta praevia were the common indications of cesarean section. Placenta praevia Respiratory rate (RR) was 5.01 (p<0.001). Other obstetric complications and risk factors were anemia, antepartum hemorrhage, hypertension, and previous cesarean section. The cross-matched transfusion ratio was 9.93 while the transfusion index and probabilities were 0.078 and 10.1 respectively. Conclusion: Our study found a higher prevalence of blood transfusion risks among pregnant women who underwent cesarean section. It has been observed that the risk of blood transfusion increased with placenta previa, preoperative maternal anemia, placenta abruption, and second stage cesarean section. During the antenatal period, the need for blood transfusion might be reduced with an increased concentration of maternal hemoglobin. Keywords: Blood transfusion, Complications, Caesarean delivery, Transfusion index

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Section: Discussionmentioning

confidence: 64%

Pattern of Blood Transfusion among Women Undergoing Caesarean Section in a Tertiary Health Care Centre

Habiba¹,

Bhattani²,

Wazir³

et al. 2021

PJMHS

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“…A more recent study did not find this relationship (AUC-ROC for fibrinogen of 0.63 and Fibtem A5 0.51). 13 An explanation for this difference is a selective study population with only 22.4% of women with PPH >1,000 mL recruited and 74 women with samples taken at >1,500 mL excluded, compared with the previous cohort of women experiencing PPH where 79.3% of women with PPH >1,000 mL were recruited and none excluded. However, an early fibrinogen of <2 g/L was still associated with 50% rate of massive transfusion, indicating that a low fibrinogen is still a risk factor for bleed progression.…”

Section: Hemostatic Changes In Pregnancy and Pphmentioning

confidence: 98%

“…In PPH of up to 1,500 mL, the incidence of laboratory fibrinogen levels of <2 g/L is low, at around 5%, with thrombocytopenia (<75 × 10 9 /L) seen in approximately 2% and PT/aPTT >1.5× reference range in 1%. 13 36 37 As the PPH volume increases (defined by either number of RBC units transfused or PPH volume), the frequency of coagulopathy also increases. In a large consecutive cohort of PPH ≥1,500 mL, on average, a plasma fibrinogen of <2 g/L did not develop until around 4,000 mL blood loss and prolongation of the PT/aPTT did not occur until blood loss exceeded 4,500 mL.…”

Section: Incidence Of Coagulation Abnormalities In Pphmentioning

confidence: 99%

“…1 7 8 9 10 The definition of massive PPH is also variable with bleed volumes ≥2,500 mL and/or transfusion of >4–8 units of RBC included. 3 11 12 13 14 The causes and contexts of these very significant bleeds are important to understand as they are associated with massive transfusion of blood and blood products, admission to intensive care, hysterectomy, and death. 12 14…”

Section: Postpartum Hemorrhage Backgroundmentioning

confidence: 99%

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The Role of Thromboelastography during the Management of Postpartum Hemorrhage: Background, Evidence, and Practical Application

Collis

Bell

2022

Semin Thromb Hemost

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Postpartum hemorrhage (PPH) is a common cause of significant maternal morbidity and mortality that can be associated with coagulopathy, especially hypofibrinogenemia. There is interest in point-of-care viscoelastic hemostatic assays (POC-VHA) in PPH because prompt knowledge of coagulation status can aid diagnosis, identify cases of severe coagulopathy, and allow ongoing monitoring during rapid bleeding. The incidence of coagulopathy in most cases of PPH is low because of the procoagulant state of pregnancy, including raised fibrinogen levels of around 4 to 6 g/L. A Clauss fibrinogen of >2 g/L or POC-VHA equivalent has been found to be adequate for hemostasis during PPH. POC-VHA has been used successfully to diagnose hypofibrinogenemia (Clauss fibrinogen of ≤2 g/L) and guide fibrinogen treatment which has reduced bleed size and complications of massive transfusion. There are uncertainties about the use of POC-VHA to direct fresh frozen plasma and platelet administration during PPH. Several POC-VHA algorithms have been used successfully incorporated in the management of many thousands of PPHs and clinicians report that they are easy to use, interpret, and aid decision making. Due to the relative cost of POC-VHA and lack of definitive data on improving outcomes, these devices have not been universally adopted during PPH.

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Women Receiving Massive Transfusion Due to Postpartum Hemorrhage: A Comparison Over Time Between 2 Nationwide Cohort Studies

Cited by 2 publications

References 0 publications

Pattern of Blood Transfusion among Women Undergoing Caesarean Section in a Tertiary Health Care Centre

Pattern of Blood Transfusion among Women Undergoing Caesarean Section in a Tertiary Health Care Centre

The Role of Thromboelastography during the Management of Postpartum Hemorrhage: Background, Evidence, and Practical Application

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