Postpartum hemorrhage treated with a massive transfusion protocol at a tertiary obstetric center: A retrospective study

Maria C Gutierrez, L. T. Goodnough, M. Druzin, A. J. Butwick

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Background: A massive transfusion protocol may offer major advantages for management of postpartum hemorrhage. The etiology of postpartum hemorrhage, transfusion outcomes and laboratory indices in obstetric cases requiring the massive transfusion protocol were retrospectively evaluated in a tertiary obstetric center. Methods: We reviewed medical records of obstetric patients requiring the massive transfusion protocol over a 31-month period. Demographic, obstetric, transfusion, laboratory data and adverse maternal outcomes were abstracted. Results: Massive transfusion protocol activation occurred in 31 patients (0.26% of deliveries): 19 patients (61%) had cesarean delivery, 10 patients (32%) had vaginal delivery, and 2 patients (7%) had dilation and evacuation. Twenty-six patients (84%) were transfused with blood products from the massive transfusion protocol. The protocol was activated within 2 h of delivery for 17 patients (58%). Median [IQR] total estimated blood loss value was 2842 [800-8000] mL. Median [IQR] number of units of red blood cells, plasma and platelets from the massive transfusion protocol were: 3 [1.75-7], 3 [1.5-5.5], and 1 [0-2.5] units, respectively. Mean (SD) post-resuscitation hematologic indices were: hemoglobin 10.3 (2.4) g/dL, platelet count 126 (44) × 109/L, and fibrinogen 325 (125) mg/dL. The incidence of intensive care admission and peripartum hysterectomy was 61% and 19%, respectively. Conclusions: Our massive transfusion protocol provides early access to red blood cells, plasma and platelets for patients experiencing unanticipated or severe postpartum hemorrhage. Favorable hematologic indices were observed post resuscitation. Future outcomes-based studies are needed to compare massive transfusion protocol and non-protocol based transfusion strategies for the management of hemorrhage.

Original languageEnglish (US)
Pages (from-to)230-235
Number of pages6
JournalInternational Journal of Obstetric Anesthesia
Volume21
Issue number3
DOIs
StatePublished - Jul 2012
Externally publishedYes

Fingerprint

Postpartum Hemorrhage
Obstetrics
Retrospective Studies
Resuscitation
Blood Platelets
Erythrocytes
Peripartum Period
Platelet Transfusion
Critical Care
Hysterectomy
Platelet Count
Fibrinogen
Medical Records
Dilatation
Hemoglobins
Mothers
Demography
Outcome Assessment (Health Care)
Hemorrhage
Incidence

Keywords

  • Blood transfusion
  • Hematologic tests
  • Postpartum hemorrhage

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Obstetrics and Gynecology

Cite this

Postpartum hemorrhage treated with a massive transfusion protocol at a tertiary obstetric center : A retrospective study. / Gutierrez, Maria C; Goodnough, L. T.; Druzin, M.; Butwick, A. J.

In: International Journal of Obstetric Anesthesia, Vol. 21, No. 3, 07.2012, p. 230-235.

Research output: Contribution to journalArticle

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abstract = "Background: A massive transfusion protocol may offer major advantages for management of postpartum hemorrhage. The etiology of postpartum hemorrhage, transfusion outcomes and laboratory indices in obstetric cases requiring the massive transfusion protocol were retrospectively evaluated in a tertiary obstetric center. Methods: We reviewed medical records of obstetric patients requiring the massive transfusion protocol over a 31-month period. Demographic, obstetric, transfusion, laboratory data and adverse maternal outcomes were abstracted. Results: Massive transfusion protocol activation occurred in 31 patients (0.26{\%} of deliveries): 19 patients (61{\%}) had cesarean delivery, 10 patients (32{\%}) had vaginal delivery, and 2 patients (7{\%}) had dilation and evacuation. Twenty-six patients (84{\%}) were transfused with blood products from the massive transfusion protocol. The protocol was activated within 2 h of delivery for 17 patients (58{\%}). Median [IQR] total estimated blood loss value was 2842 [800-8000] mL. Median [IQR] number of units of red blood cells, plasma and platelets from the massive transfusion protocol were: 3 [1.75-7], 3 [1.5-5.5], and 1 [0-2.5] units, respectively. Mean (SD) post-resuscitation hematologic indices were: hemoglobin 10.3 (2.4) g/dL, platelet count 126 (44) × 109/L, and fibrinogen 325 (125) mg/dL. The incidence of intensive care admission and peripartum hysterectomy was 61{\%} and 19{\%}, respectively. Conclusions: Our massive transfusion protocol provides early access to red blood cells, plasma and platelets for patients experiencing unanticipated or severe postpartum hemorrhage. Favorable hematologic indices were observed post resuscitation. Future outcomes-based studies are needed to compare massive transfusion protocol and non-protocol based transfusion strategies for the management of hemorrhage.",
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