The incidence, aetiology, and coagulation management of massive postpartum haemorrhage: a two-year national prospective cohort study.
Int J Obstet Anesth
; 47: 102983, 2021 08.
Article
in En
| MEDLINE
| ID: mdl-33994274
ABSTRACT
INTRODUCTION:
Between 2017 and 2018 a national quality improvement initiative was introduced incorporating point-of-care viscoelastic haemostatic assays (VHA) to guide blood product transfusion. Laboratory coagulation profiles, use and results of VHA, and administration of blood products were investigated.METHODS:
A two-year prospective cohort study of maternal outcomes of women experiencing massive postpartum haemorrhage (PPH) >1000â¯mL in Wales. In this study, cases of massive PPH (≥2500â¯mL and/or ≥5 units red blood cell (RBC) transfusion) were identified.RESULTS:
Massive PPH occurred in 349 of 60 914 maternities (rate 5.7 per 1000). There were no deaths from PPH. Intensive care unit admission and/or hysterectomy occurred in 34/311 (10.9%) and 16/347 (4.6%), respectively. The leading cause of massive PPH was genital tract trauma (107/349, 30.6%). Two hundred and seventy-nine (80.6%) required RBC transfusion and 79/345 (22.9%) received at least one blood coagulation product. Results of VHA were recorded in 245/349 (70.2%), with 44/98 (44.9%) women tested in the first six months vs 63/77 (81.8%) in the final six months. Hypofibrinogenaemia (Clauss fibrinogen <2â¯g/L or FIBTEM A5 <12â¯mm) was observed in 56/328 (17.1%) of women, thrombocytopaenia (count <75â¯×â¯109/L) in 17/334 (5.1%) and either PT or aPTT >1.5×reference range in 10/293 (3.4%).CONCLUSION:
In Wales, the use of VHA in cases of massive PPH increased over time, enabling clinicians to adopt a targeted, patient-specific approach to blood product administration, with only 22.9% of women receiving blood coagulation products and 17.1% having a documented clotting abnormality.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Postpartum Hemorrhage
Type of study:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Female
/
Humans
Language:
En
Journal:
Int J Obstet Anesth
Journal subject:
ANESTESIOLOGIA
/
OBSTETRICIA
Year:
2021
Document type:
Article