Patient Blood Management programs for post-partum hemorrhage

Delgado, Carlos; Komatsu, Ryu

doi:10.1016/j.bpa.2022.09.001

Cited by 4 publications

(7 citation statements)

References 80 publications

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“…Overall, PPH increases the risk for RBC transfusions associated with potential maternal complications ( 15 , 26 , 27 ). In our analyses intrapartum hemorrhage occurred in 5.6% and PPH in 11.1% in all EXIT procedures conducted.…”

Section: Discussionmentioning

confidence: 99%

Maternal anemia and red blood cell requirements in 72 women undergoing ex-utero intrapartum treatment (EXIT) procedure

Kloka,

Jasny,

Jennewein

et al. 2024

Front. Med.

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BackgroundThe ex-utero intrapartum treatment (EXIT) allows to ensure fetal airway while keeping uteroplacental circulation. However, EXIT may become a life-threatening procedure due to the increased risk of uterine atony or placenta abruption with increased peripartum blood losses and increased transfusion rates. We aim to review maternal anemia prevalence and transfusion requirements in women undergoing EXIT procedure.MethodsUsing data from the Federal German Statistical Office hospitalized women undergoing EXIT procedure between January 1st 2006 and December 31st 2021 were included. The prevalence of anemia, peripartum hemorrhage, comorbidities and administration of red blood cells (RBC) were analyzed.ResultsIn total, 72 women underwent EXIT procedure with a median age of 31 years (26;33.5). In 43.1% EXIT was conducted at 34–36 weeks of gestational age. “Anemia during pregnancy” was present in 47.2%, “anemia due to acute bleeding” in 25.0% and “iron deficiency anemia” in 15.3%. Postpartum hemorrhage occurred in 11.1%. RBCs were transfused in 15.3% of all women. Most women required 1–5 units of RBCs.ConclusionDespite the rarity of this procedure, anemia management and blood conservation strategies in order to reduce the need for RBC transfusion are highly important in women undergoing EXIT procedure.

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Section: Discussionmentioning

confidence: 99%

Maternal anemia and red blood cell requirements in 72 women undergoing ex-utero intrapartum treatment (EXIT) procedure

Kloka,

Jasny,

Jennewein

et al. 2024

Front. Med.

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“…Irrespective of which definition is used, severe PPH increases the risk of the need for red blood cell transfusions associated with potential complications for the mother [ 5 , 8 , 13 ▪ ]. This risk is increased in patients suffering from preexisting anemia.…”

Section: Peripartum Hemorrhagementioning

confidence: 99%

“…In addition to the above, uterine atony, placental anomalies, preeclampsia, coagulopathies, and a preexisting anemia have been described as the most common obstetrical risk factors for PPH [ 3 , 8 , 10 , 13 ▪ , 14 ]. It is of utmost importance, however, to take into consideration that PPH can occur during every pregnancy and the majority of women developing a PPH have none of the described risk factors [ 3 , 8 ].…”

Section: Peripartum Hemorrhagementioning

confidence: 99%

“…It is of utmost importance, however, to take into consideration that PPH can occur during every pregnancy and the majority of women developing a PPH have none of the described risk factors [ 3 , 8 ]. Even using a scoring system to identify women at risk often fails in daily practice due to their lack of reliability, thus there is need for further improvement [ 10 , 13 ▪ ]. In recent years, artificial intelligences and machine learning has been applied to perform an unbiased approach to hemorrhage risk prediction, which eventually may be superior to human risk assessment and represents an area for future research [ 15 ▪ ].…”

Section: Peripartum Hemorrhagementioning

confidence: 99%

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Current concepts in preoperative anemia management in obstetrics

Wiesenack

Meybohm

Neef

et al. 2023

Current Opinion in Anaesthesiology

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Purpose of reviewThe purpose of this article is to provide an overview of currently recommended treatment approaches for anemia during pregnancy, with a special focus on iron deficiency and iron deficiency anemia (IDA).Recent findingsAs consistent patient blood management (PBM) guidelines in obstetrics are still lacking, recommendations regarding the timing of anemia screening and the treatment recommendations for iron deficiency and IDA during pregnancy are still controversial. Based on increasing evidence, early screening for anemia and iron deficiency should be recommended at the beginning of each pregnancy. To reduce maternal and fetal burden, any iron deficiency, even without anemia, should be treated as early as possible during pregnancy. While oral iron supplements administered every other day are the standard treatment in the first trimester, the use of intravenous iron supplements is increasingly suggested from the second trimester onwards.SummaryThe treatment of anemia, and more specifically iron deficiency anemia during pregnancy, holds many possibilities for improvement. The fact that the period of risk is known well in advance and thus there is a long optimization phase is per se an ideal prerequisite for the best possible therapy of treatable causes of anemia. Standardization of recommendations and guidelines for screening and treatment of IDA in obstetrics is required for the future. In any case, a multidisciplinary consent is the precondition for a successfully implementation of anemia management in obstetrics to establish an approved algorithm easily enabling detection and treatment of IDA during pregnancy.

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“…During pregnancy, non-specific leukocytosis, displacement of the abdominal and pelvic organs by the gravid uterus, and difficulty of physical examination can make clinical assessment challenging, especially in the third trimester [ 1 , 2 ]. On the other hand, the postpartum period, which may take as long as 8 weeks from birth, is also burdened by a broad spectrum of complications, significantly dependent on the delivery method: postpartum hemorrhage is the leading cause of maternal mortality world-wide [ 3 ]. Diagnostic imaging is often required to elucidate a complex clinical scenario in pregnancy and puerperium, playing a crucial role in the assessment of complications and expediting diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium—Part I: Obstetric (Non-Fetal) Complications

Bonito,

Masselli,

Gigli

et al. 2023

Diagnostics

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Acute abdominopelvic pain in pregnant and postpartum patients presents clinical and therapeutic challenges, often requiring quick and accurate imaging diagnosis. Ultrasound remains the primary imaging investigation. Magnetic resonance imaging (MRI) has been shown to be a powerful diagnostic tool in the setting of acute abdominal pain during pregnancy and puerperium. MRI overcomes some drawbacks of US, avoiding the ionizing radiation exposure of a computed tomography (CT) scan. Although CT is not usually appropriate in pregnant patients, it is crucial in the emergency evaluation of postpartum complications. The aim of this article is to provide radiologists with a thorough familiarity with the common and uncommon pregnancy and puerperium abdominal emergencies by illustrating their imaging appearances. The present first section will review and discuss the imaging findings for acute abdominopelvic pain of obstetric (non-fetal) etiology.

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Patient Blood Management programs for post-partum hemorrhage

Cited by 4 publications

References 80 publications

Maternal anemia and red blood cell requirements in 72 women undergoing ex-utero intrapartum treatment (EXIT) procedure

Maternal anemia and red blood cell requirements in 72 women undergoing ex-utero intrapartum treatment (EXIT) procedure

Current concepts in preoperative anemia management in obstetrics

Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium—Part I: Obstetric (Non-Fetal) Complications

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