Blood component therapy in obstetrics

Risk factors for blood component therapy in parturients-Case-control study

OBJECTIVE

Postpartum hemorrhage is a major cause of maternal morbidity and mortality, so early identification of patients at risk is crucial. In this study, we aim to assess the risk factors for major transfusion in parturients.

METHODS

A case-control study was conducted between 2011 and 2019. The cases included women who were treated with postpartum major transfusion compared with two control groups, one of which was treated with 1-2 packed red blood cells and one of which was not treated with packed red blood cells. Cases were matched with controls based on two variables: multiple pregnancies and previous history of three or more cesarean sections. A multivariable conditional logistic regression model was used to determine the role of the independent risk factors.

RESULTS

Of the 187 424 deliveries included in the present study, 246 (0.3%) women were treated with major transfusions. After applying a multivariate analysis, maternal age (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.996-1.16), antenatal anemia with hemoglobin less than 10 g/dL (OR 12.58, 95% CI 2.86-55.25), retained placenta (OR 5.5, 95% CI 2.15-13.78), and cesarean delivery (OR 10.12, 95% CI 0.93-1.95) remained independent risk factors for major transfusions.

DISCUSSION

Retained placenta and antenatal anemia (hemoglobin < 10 g/dL) are independent risk factors for major transfusion. Of these, anemia was found to be the most significant.

Blood Component Utilization for Disseminated Intravascular Coagulation (DIC) Cases with Respect to Underlying Condition

To understand transfusion requirement in DIC with respect to (wrt) underlying cause. Patients' details were analyzed using parameters like yearly requirement, hemoglobin (Hb) and blood components utilization wrt age, sex and cause of DIC. Total 1931 DIC cases from 167 hospitals received 21,153 blood units including whole blood, red cell concentrate fresh frozen plasma, random donor platelets, single donor platelets and cryoprecipitate from year 2001 to 2013. Significant risk of DIC was for females compared to males (p < 0.0001). Whole blood utilization was 25.5 % in 2001 which reduced to 1.2 % in 2013. Mean ± SD Hb concentration was 8.6 ± 3.0 in females and 9.8 ± 3.2 g/dL in males. The lowest mean Hb was 7 g/dL in female DIC cases having malignancy. Septicemia was the major cause of DIC followed by obstetric complications. The highest requirement was for trauma associated with septicemia, requiring 35 units/case. Combination of two or more underlying causes for DIC increased the blood component requirement.

Emergent management of postpartum hemorrhage for the general and acute care surgeon

BACKGROUND

Postpartum hemorrhage is one of the rare occasions when a general or acute care surgeon may be emergently called to labor and delivery, a situation in which time is limited and the stakes high. Unfortunately, there is generally a paucity of exposure and information available to surgeons regarding this topic: obstetric training is rarely found in contemporary surgical residency curricula and is omitted nearly completely from general and acute care surgery literature and continuing medical education.

METHODS

The purpose of this manuscript is to serve as a topic specific review for surgeons and to present a surgeon oriented management algorithm. Medline and Ovid databases were utilized in a comprehensive literature review regarding the management of postpartum hemorrhage and a management algorithm for surgeons developed based upon a collaborative panel of general, acute care, trauma and obstetrical surgeons' review of the literature and expert opinion.

RESULTS

A stepwise approach for surgeons of the medical and surgical interventions utilized to manage and treat postpartum hemorrhage is presented and organized into a basic algorithm.

CONCLUSION

The manuscript should promote and facilitate a more educated, systematic and effective surgeon response and participation in the management of postpartum hemorrhage.