Comparison of haematological indices and transfusion management in severe and massive postpartum haemorrhage: analysis of a two-year national prospective observational study

• Published in: International journal of obstetric anesthesia 2022-05, Vol.50, p.103547-103547, Article 103547
• Main Authors: Bell, S.F., Collis, R.E., Collins, P.W.
• Format: Article
• Language: English
• Subjects: Abruption; Afibrinogenemia; Blood Coagulation Disorders; Blood Transfusion; Coagulopathy; Female; Fibrinogen; Fibrinogen - analysis; Fibrinogen - therapeutic use; Hemostatics; Humans; Postpartum haemorrhage; Postpartum Hemorrhage - therapy; Pregnancy; Prospective Studies
• ISSN: 0959-289X; 1532-3374
• DOI: 10.1016/j.ijoa.2022.103547

•A prospective cohort study compared severe and massive postpartum haemorrhage (PPH).•Red blood cells were transfused to 42.5% severe and 80.6% massive PPH cases.•Hypofibrinogenemia occurred in 5.4% severe and 17.0% massive PPH cases.•Blood coagulation products were received by 3.6% severe and 22.9% massive PPH cases.•Early targeted fibrinogen therapy in cases of abruption requires further evaluation. This two-year prospective cohort study compared the management of women experiencing severe or massive postpartum haemorrhage (PPH) to explore the impact of targeted blood product administration on reducing PPH progression (from >1500 mL to ≥2500 mL blood loss). During the study, viscoelastic haemostatic assays (VHA) guided blood product transfusion. All women experiencing blood loss after PPH >1000 mL were included in a national database. Haematological indices, transfusion and PPH aetiology were analysed in severe (>1500 mL blood loss or transfusion of any blood product) and massive PPH (≥2500 mL blood loss or transfusion ≥5 units red blood cells). Of the 61 094 maternities in Wales (2017 to 2018), 2111 had severe and 349 massive PPH. Red blood cells were transfused to 42.5% severe and 80.6% massive PPH cases. Hypofibrinogenaemia (fibrinogen