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6.4 Transfusion management and haemostatic changes in major obstetric haemorrhage in the UK
  1. L Green1,
  2. M Knight2,
  3. FM Seeney3,
  4. PW Collins4,
  5. RE Collis5,
  6. CL Hopkinson3,
  7. SJ Stanworth6
  1. 1Barts Health NHS Trust, NHS Blood and Transplant, London, UK
  2. 2National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
  3. 3Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
  4. 4Arthur Bloom Haemophilia Centre, Cardiff University, Cardiff, UK
  5. 5Department of Anaesthetics, Cardiff and Vale University Health Board, Cardiff, UK
  6. 6NHS Blood and Transplant, Oxford University Hospitals NHS Trust, Oxford, UK

Abstract

Blood transfusion is fundamental to improving outcomes during major obstetric haemorrhage (MOH). Current guidelines recommend that fresh frozen plasma (FFP), cryoprecipitate and platelets are transfused when PT/APTT is >1.5 × baseline, fibrinogen <1 g/dL and platelet count <50 × 109/L, respectively. However, these recommendations are not evidence-based.

Aims to describe coagulation abnormalities and transfusion requirements during MOH (defined as transfusion of ≥8 units of RBC within 24 hrs of delivery).

Methods Cases were identified using the UK Obstetric Surveillance System, between July 2012 and June 2013.

Results We identified 181 cases; 68% delivered by caesarean. The median estimated blood loss was 6000 mL (IQR: 4500–8000). The main causes for MOH were uterine atony (40%) and placenta accreta/increta/percreta (16%). The median (IQR) platelet count, APTT-ratio and fibrinogen (worst values) were 68 x 109/L (50–95), 1.3 (1.0–1.9) and 1.4 (0.8–2.2) respectively. In 33%, 27% and 25% of cases APTT-ratio was >1.5x baseline, fibrinogen <1.0 g/dL and platelet <50 × 109/L respectively. FFP, cryoprecipitate and platelets were transfused in 99%, 61% and 77% of women. The median (IQR) RBC, FFP and cryoprecipitate transfused were: 10 (8–1), 6 (4–8), and 2 units (2–4), with the first FFP and cryoprecipitate transfused after a median of 4 (3–6) and 7 RBC units (6–9) respectively. 45% of women underwent hysterectomy, 2 died, 82% were admitted to ITU/HDU, and 28% developed additional major morbidity.

Conclusion Guideline criteria for plasma/platelet transfusion were fulfilled in only 25% of these severe cases, indicating that further research is needed to define transfusion triggers in MOH.

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