Postpartum hemorrhage: Blood product management and massive transfusion

Kogutt, Benjamin K.; Vaught, Arthur J.

doi:10.1053/j.semperi.2018.11.008

Cited by 27 publications

(28 citation statements)

References 51 publications

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“…Some community and rural hospitals may have limited stock of blood components (especially during blood shortages). In these areas, comprehensive guidelines for alternative therapies, which may include use of blood component therapies, TXA, fibrinogen concentrate, and prothrombin complex concentrates (ACOG, 2017; Kogutt & Vaught, 2019), should be available.…”

Section: Managementmentioning

confidence: 99%

Postpartum Hemorrhage

Wilbeck

Hoffman

Schorn

2022

Advanced Emergency Nursing Journal

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Postpartum hemorrhage (PPH) represents total cumulative blood loss in excess of 1,000 ml or blood loss accompanied by signs and/or symptoms of hypovolemia within 24 hr following birth (The American College of Obstetricians and Gynecologists [ACOG], 2017). As a large number of PPHs occur in low-risk women (ACOG, 2019), the emergency nurse practitioner must be prepared to identify and manage this uncommon but life-threatening condition. The etiology, pharmacological management strategies, and other interventions are reviewed in an algorithmic approach. This organized approach not only supports maternal survival during PPH but is also applicable to postprocedural bleeding of obstetric and gynecological etiologies.

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Section: Managementmentioning

confidence: 99%

Postpartum Hemorrhage

Wilbeck

Hoffman

Schorn

2022

Advanced Emergency Nursing Journal

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“…Another main cause of perinatal blood transfusions is severe predelivery anemia, which can be improved by planned blood transfusions before Cesarean Section. The components of blood transfusions in obstetrics mainly include packed red blood cells (PRBCs), platelets, and fresh frozen plasma (FFP) or cryoprecipitate [ 4 ]. Due to the skewed estimation of blood loss and clinical symptoms in postpartum women, blood transfusions can be used to roughly assess the presence of the severe PPH.…”

Section: Introductionmentioning

confidence: 99%

A risk prediction model of perinatal blood transfusion for patients who underwent cesarean section: a case control study

Wang

Hong

2022

BMC Pregnancy Childbirth

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Background Severe obstetric hemorrhage is a leading cause of severe maternal morbidity. A perinatal blood transfusion is the key factor in the treatment of severe obstetric hemorrhage. Our aim is to identify patients with a high risk of perinatal blood transfusions before Cesarean Section, which can promote the effectiveness of the treatment of severe obstetric hemorrhage, as well as improve obstetric preparations. Methods This study retrospectively analyzed the data of 71 perinatal blood transfusion patients and 170 controls, who were both underwent Cesarean Section from July 2018 to September 2019. These data were included in the training set to build the risk prediction model of needing blood transfusion. Additionally, the data of 148 patients with the same protocol from October 2019 to May 2020 were included in the validation set for model validation. A multivariable logistic regression model was used. A risk prediction nomogram was formulated per the results of the multivariate analysis. Results The strongest risk factors for perinatal blood transfusions included preeclampsia (OR = 6.876, 95% CI: 2.226–23.964), abnormal placentation (OR = 5.480, 95% CI: 2.478–12.591), maternal age (OR = 1.087, 95% CI: 1.016–1.166), predelivery hemoglobin (OR = 0.973, 95% CI: 0.948–0.998) and predelivery fibrinogen (OR = 0.479, 95% CI: 0.290–0.759). A risk prediction model of perinatal blood transfusions for cesarean sections was developed (AUC = 0.819; sensitivity: 0.735; specificity: 0.848; critical value: 0.287). Conclusions The risk prediction model can identify the perinatal blood transfusions before Cesarean Section. With the nomogram, the model can be further quantified and visualized, and clinical decision-making can subsequently be further simplified and promoted.

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“…2 In addition to strengthening the patient's uterus contractions, drug haemostasis, surgery, etc, massive blood transfusion (MBT) also plays a key role in the treatment of obstetric haemorrhage. [3][4][5][6] MBT occurs when large volumes of blood products are administered over a short period of time, as a 'maternal near miss event', it signifies major obstetric haemorrhage and requires extensive coordination of the obstetric, anaesthesia and blood bank teams. 7 8 The incidence of MBT in relation to delivery or postpartum haemorrhage (PPH) has been reported to be 2.3-10.0 per 10 000 maternities in high-resource countries, [9][10][11][12][13] and an increasing trend in the rate of MBT post partum has been reported in Sweden.…”

Section: Introductionmentioning

confidence: 99%

Incidence, trends and risk factors for obstetric massive blood transfusion in China from 2012 to 2019: an observational study

Xie

Liang

et al. 2021

BMJ Open

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ObjectivesThis study aims to use the high-quality national monitoring data from the China’s National Maternal Near Miss Surveillance System (NMNMSS) to ascertain the incidence, trends and risk factors of obstetric massive blood transfusion (MBT) from 2012 to 2019 in China and determine its clinical outcomes.SettingsObservational study of hospitalised pregnancies who had given birth or ended their pregnancy among member hospitals of NMNMSS.Participants11 667 406 women were included in this study.Primary and secondary outcome measuresWe screened for the incidence, trends, risk factors and main reasons for obstetric MBT, and the outcomes after obstetric MBT. MBT was defined as the transfusion of ≥5 units of red blood cells or ≥1000 mL of whole blood. The incidence of MBT was defined as the MBT cases per 10 000 pregnancies.ResultsObstetric MBT occurred in 27 626 cases, corresponding to an incidence of 23.68 per 10 000 maternities, which exhibited an increasing trend in China during 2012–2019 (14.03–29.59 per 10 000 maternities, p for trend <0.001). Obstetric MBT was mainly associated with amniotic fluid embolism, uterine atony, abnormal placenta, severe anaemia, ectopic pregnancy, abortion, caesarean section, advanced maternal age and multiparous from biological effect. While from sociological effects, uterine atony, severe anaemia and placenta previa are the top three complications which more likely to undergo obstetric MBT in the Chinese population. Overall, the secular trends of hysterectomy incidence (25.07%–9.92%) and MMR during hospitalisation (21.41‰–7.48‰) among women who underwent MBT showed decreasing trends (p for trend <0.001).ConclusionTo minimise the incidence of obstetric MBT, more attention should be paid to education on the importance of the antenatal visit, evidence-based transfusion practice and females who are multiparous and have an advanced age, amniotic fluid embolism, uterine atony, severe anaemia and placenta previa.

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Postpartum hemorrhage: Blood product management and massive transfusion

Cited by 27 publications

References 51 publications

Postpartum Hemorrhage

Postpartum Hemorrhage

A risk prediction model of perinatal blood transfusion for patients who underwent cesarean section: a case control study

Incidence, trends and risk factors for obstetric massive blood transfusion in China from 2012 to 2019: an observational study

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