Comparison of haematological indices and transfusion management in severe and massive postpartum haemorrhage: analysis of a two-year national prospective observational study |
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| Affiliation: | 1. Department of Anaesthetics, Intensive Care and Pain Medicine, Cardiff and Vale University Health Board, Cardiff, UK;2. Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK;1. Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel affiliated with Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel;2. Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel;3. Division of Anesthesia, Operating Rooms, Pain, and Critical Care, Samson Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod, Israel;4. Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Hebrew University Hadassah Medical School, Jerusalem, Israel;5. Department of Anesthesiology, Critical Care, and Pain Medicine, Hadassah Hebrew University Medical Center, Jerusalem affiliated with Hebrew University Medical School, Jerusalem, Israel;6. Shamir Medical Center, Zrifin, Israel affiliated with Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel;7. Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel;8. Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel affiliated with Faculty of Health Sciences Ben Gurion University, Israel;1. Department of Obstetrics, Gynecology and Women’s Health, Montefiore Medical Center, Bronx, NY, USA;2. Department of Statistics, Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, USA;3. Albert Einstein College of Medicine, Bronx, NY, USA |
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| Abstract: | IntroductionThis two-year prospective cohort study compared the management of women experiencing severe or massive postpartum haemorrhage (PPH) to explore the impact of targeted blood product administration on reducing PPH progression (from >1500 mL to ≥2500 mL blood loss). During the study, viscoelastic haemostatic assays (VHA) guided blood product transfusion.MethodsAll women experiencing blood loss after PPH >1000 mL were included in a national database. Haematological indices, transfusion and PPH aetiology were analysed in severe (>1500 mL blood loss or transfusion of any blood product) and massive PPH (≥2500 mL blood loss or transfusion ≥5 units red blood cells).ResultsOf the 61 094 maternities in Wales (2017 to 2018), 2111 had severe and 349 massive PPH. Red blood cells were transfused to 42.5% severe and 80.6% massive PPH cases. Hypofibrinogenaemia (fibrinogen <2 g/L and/or Fibtem A5 <12 mm) was the most frequent coagulation abnormality, occurring in 5.4% severe and 17.0% massive PPH, with blood coagulation products (fresh frozen plasma, platelets, cryoprecipitate and/or fibrinogen concentrate) administered to 3.6% and 22.9%. Women with hypofibrinogenaemia received targeted fibrinogen replacement in 97.8% severe and 93.6% massive PPH. The only aetiology with similar rates of hypofibrinogenaemia in severe and massive PPH was abruption (40.0% and 36.8%).ConclusionHypofibrinogenaemia was less frequent in severe PPH, although coagulopathy was observed across a range of PPH aetiologies, highlighting the importance of coagulation testing for all. Cases of abruption in severe and massive PPH had similar rates of hypofibrinogenaemia. Early VHA-guided fibrinogen replacement may reduce PPH progression in abruption and requires further evaluation. |
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| Keywords: | Abruption Coagulopathy Fibrinogen Postpartum haemorrhage |
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