Abstract
Background and objectives: Massive postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide. A massive transfusion protocol (MTP) may be used to provide significant benefits in the management of PPH; however, only a limited number of hospitals use MTP protocol to manage massive obstetric hemorrhages, especially in Japan. This study aimed to assess the clinical outcomes in patients in whom MTP was activated in our hospital. Materials and Methods: We retrospectively reviewed the etiology of PPH, transfusion outcomes, and laboratory findings among the patients treated with MTP after delivery in our hospital. Results: MTP was applied in 24 cases (0.7% of deliveries). Among them, MTP was activated within 2 h of delivery in 15 patients (62.5%). The median estimated blood loss was 5017 mL. Additional procedures to control bleeding were performed in 19 cases, including transarterial embolization (18 cases, 75%) and hysterectomy (1 case, 4.2%). The mean number of units of red blood cells, fresh frozen plasma, and platelets were 17.9, 20.2, and 20.4 units, respectively. The correlation coefficients of any two items among red blood cells, fresh frozen plasma, platelets, blood loss, and obstetrical disseminated intravascular coagulation score ranged from 0.757 to 0.892, indicating high levels of correlation coefficients. Although prothrombin time and activated partial thromboplastin time levels were significantly higher in the <150 mg/dL fibrinogen group than in the ≥150 mg/dL fibrinogen group at the onset of PPH, the amount of blood loss and blood transfusion were comparable between the two groups. Conclusions: Our MTP provides early access to blood products for patients experiencing severe PPH and could contribute to improving maternal outcomes after resuscitation in our hospital. Our study suggests the implementation of a hospital-specific MTP protocol to improve the supply and utilization of blood products to physicians managing major obstetric hemorrhage.
Highlights
Massive postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide [1,2]
We found that the obstetrical disseminated intravascular coagulation (DIC) score, which indicates the severity of DIC, was high in the patients treated with massive transfusion protocol (MTP)
A hospital-based MTP specific to the obstetric field can provide life-saving transfusion therapy for patients presenting with severe PPH
Summary
Massive postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide [1,2]. Life-threatening massive PPH occurs in one out of every 300 cases [3], and its onset is difficult to predict before delivery Once it occurs, it can result in nonstandard requests for blood products without any protocol guiding the administration of a large amount of blood in a short period. Massive transfusion in obstetrics requires extensive collaboration between the obstetrics, anesthesiology, and transfusion teams and consumes a large amount of blood in hospitals with limited blood product storage [7]. Conclusions: Our MTP provides early access to blood products for patients experiencing severe PPH and could contribute to improving maternal outcomes after resuscitation in our hospital. Our study suggests the implementation of a hospital-specific MTP protocol to improve the supply and utilization of blood products to physicians managing major obstetric hemorrhage
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