Transfusion et hémorragie du post-partum

[Transfusion strategy for patients with severe postpartum hemorrhage: a retrospective study of 47 cases]

INTRODUCTION

Postpartum haemorrhage is the leading cause of maternal morbidity and mortality worldwide. It requires a multidisciplinary approach. Transfusion strategy is essential, playing a key role in maternal prognosis. This study aims to determine FFP/RBC ratio (plasma frais congelé/concentrés de globules rouges; fresh frozen plasma/red blood cells) during the treatment of serious postpartum haemorrhages.

METHODS

We conducted a retrospective study at a Maternity Referral Center (level III) in eastern Tunisia over a period of 4 years (2009-2012). All parturients admitted due to severe postpartum bleeding requiring transfusion of more than 4 Units of RBC during the first 3 hours or of more than 10 Units of RBC during the first 24 hours of treatment were included in the study.

RESULTS

47 parturients were enrolled in our study. The diagnosis of PPH was made on the basis of vaginal bleeding in 28 cases and following cesarean section in 19 cases. Preoperative hemoglobin level was of 6.3 g/dl. Transfusion ratio (FFP/RBC) was 1/0.7.

CONCLUSION

During tratment transfusion ratio was greater than that indicated in the existing guidelines stating an early and massive administration of FFP with a FFP/RBC ratio ranging between 1/2 and 1/1. Fibrinogen (Fbg) and tranexamic acid should be administered as early as possible. The use of recombinant activated factor VII (rFVIIa) should remain the ultimate treatment option.

[Evaluation of midwives transfusion knowledge in Brittany public and private maternities, 2014]

OBJECTIVES

This regional study aims to evaluate the transfusion knowledge of midwives in 22 Brittany maternity hospitals.

MATERIALS AND METHODS

A multicentre, descriptive and comparative study used a questionnaire consisting in 16 theoretical questions about transfusion and questions being carried out. The analysis used the rate of correct answers and a pondered coefficient has been assigned to the different questions to evaluate the level of midwife knowledge.

RESULTS

Twenty-two maternity hospitals participated in the study and 238 returned questionnaires could be analysed, a return rate of 36%. The rate of correct answers was between 5 and 98% depending on the questions; for example, the rate of correct answers of the ultimate control's reading varied between 64 and 98% and revealed that 5 to 7% of midwives would validate an incompatible transfusion. The average score was 31/50 with a minimum of 7/50 and a maximum of 44/50. Three statically significant links have been found according to the last year of training specific to blood transfusion, the graduation year and the level of maternity.

CONCLUSION

This study revealed an insufficient knowledge of the transfusion among midwives and raised prospects, which could lead to an improvement of training courses offered to midwives.