Major obstetric haemorrhage - how did we get away with not transfusing blood products?

ABSTRACT

Introduction: The recent increase in the rate of massive obstetric haemorrhage (MOH) has been associated with an increase in maternal age, body mass index, rate of caesarean sections (CS) and associated co-morbidities [1]. Timely and effective management of MOH is essential for ensuring the safety of both mother and baby. Most literature is aimed at identifying risk factors for MOH and triggers for transfusion. In this service evaluationwe aim to characterise the MOH patients that did not require a blood transfusion and identify any areas for improvement that can be extrapolated to the patients who received transfusions. Methods:We conducted an electronic patient data search (K2 system) to identify all parturients with more than 1500 mL peripartum blood loss, between March 2020 and April 2021. All patientswere included in the service evaluation. We collected demographic data, BMI, parity, cause of haemorrhage, mode of delivery and type of anaesthesia, treatment, initial and post 24 h haemoglobin results, fibrinogen results and COVID-19 status. Approval was requested from the Audit department and the Caldicott Guardian. Results: Data were collected for 139 patients. Mean (±SD) patient age was 31.5 (±5.4) and 38% of patients were ASA1. (Table Presented) Discussion: Patients with an estimated blood loss (EBL) less than 1500 mL were not included as we usually manage them conservatively. Our data support the recommendations of the Royal College of Obstetricians that antenatal anaemia needs investigating and treating appropriately to reduce the morbidity associated with PPH and the need for transfusions [2]. There was higher incidence of CS and atony in the group requiring transfusion suggesting that improved patient information on the use of uterotonics and restricting CS to clear clinical indications could further reduce transfusion rates.