Effects of a Massive Transfusion Protocol in Obstetric and Gynecologic Populations

Abstract

Childbearing Poster Presentation Background Large volume blood loss management is vital to survival, especially in obstetric and gynecologic surgery in women of childbearing age. For this reason a protocol was developed to ensure availability of blood products for transfusion during acute blood loss in this patient population. Case After a failed trial of labor, a woman consented to a cesarean delivery, which resulted in the loss of 1 L of blood after the birth. In the recovery room, the woman reported increasing abdominal pain from her right pelvis to her right upper quadrant. As her blood pressure decreased, the team quickly attempted to stabilize her, and she was moved back to the operating room for exploration. A massive transfusion protocol (MTP) was initiated because of a large hemoperitoneum (blood collection in the abdomen) of 3.5 L (total estimated blood loss of 4.5 L). Surgical repair of a right cervicovaginal laceration was performed as eight units of packed red blood cells (PRBC), two units of fresh frozen plasma (FFP), and a pack of platelets was transfused. The woman remained on mechanical ventilation and was admitted to the women's intensive care unit where she remained intubated overnight. A review of the laboratory results revealed a decrease in hemoglobin from 10.7 mg/dl on admission to 6.5 mg/dl, with a return to 11.6 mg/dl the day following these interventions. The breathing tube was removed the same day, and the woman was discharged home on day 6 after the MTP was initiated. Conclusion The MTP was initiated in 2010 along with a maternal urgent surgical team to manage this complex population. Each cooler from the blood bank contains six units of PRBC, six units of FFP, and a pack of platelets. During the MTP, the blood bank will release a cooler every 20 minutes until the MTP leader terminates the MTP. From December 2010 to December 2012, 43 protocols (MTP I: 22; MTP II: 21) were used in obstetric and gynecologic patients. The ratio of red blood cells to FFP transfusion ranged from 1:0.54 to 1:0.66; the mean patient age was 33.6 years. The average length of stay (LOS) from time of MTP to patient discharge was 4.3 to 5 days with a mean LOS in the intensive care unit of 2.3 days. Exemplary practice and quality outcomes are a direct result of this collaborative effort in patient-first care.