Research of reasons and therapeutic effect of blood transfusion therapy in postpartum hemorrhage patients

Abstract

Objective To analyze the reasons and therapeutic effect of blood transfusion therapy in postpartum hemorrhage (PPH) patients, and provide references for making blood transfusion strategies for PPH patients. Methods The clinical data of a total of 185 cases of PPH patients who delivered and received blood transfusion therapy (erythrocyte suspension transfusion volume ≥ 4 U) because of PPH in Department of Obstetrics of First Affiliated Hospital of Third Military Medical University (Southwest Hospital) from January 2008 to December 2012 were analyzed by retrospective analysis method. The age, gravidity, parity, delivery method, macrosomia, number of fetus, pregnancy complications, bleeding volume, transfusion volume and blood transfusion therapy effects and so on of all the patients were collected. The reasons of blood transfusion therapy of all PPH patients with blood transfusion, the blood transfusion volume of blood transfusion PPH patients with different clinical characters, the general clinical data and therapy measures of PPH patients with massive transfusion were analyzed by statistical methods. The study protocol was approved by the Ethical Review Board of Investigation in the First Affiliated Hospital of Third Military Medical University (Southwest Hospital). Results ①The main reasons of blood transfusion therapy among the 185 cases of PPH patients with blood transfusion in this study included: placenta previa (61 cases, 33.0%), placenta conglutination, implanted placenta, or residual placenta (15 cases, 8.1%), uterine inertia (40 cases, 21.6%), coagulation dysfunction (30 cases, 16.2%), anemia (33 cases, 17.8%) and other factors (6 cases, 3.2%). ②The median blood transfusion volume of PPH patients with parity times ≥ 2 times was 1 250 mL which was statistically higher than that of patients with parity times 0.05). ③With manual massage of the uterus, using contractions promote drugs, using balloon to oppress the uterus, blood transfusion and other conventional treatments or surgical treatments, all the 185 cases of PPH patients with blood transfusion in this study were effectively controlled and no one was died for PPH. ④Among the 185 cases of PPH patients with blood transfusion in this study, 8 cases received massive transfusion therapy (erythrocyte suspension transfusion volume ≥ 18 U within 24 hours), of which 7 cases were with placenta previa or placental implantation, the average bleeding volume and average volume of blood transfusion were (4 800.0±680.7) mL and (3 685.7±157.4) mL, respectively, and 1 case was with uterine atony. All the 8 cases of PPH patients with massive transfusion received fresh frozen plasma (FFP) transfusion after they were transfused with 3~5 U of red blood cell suspension, and the transfusion volume ratio of FFP and red blood cell was about 1∶1. Conclusions We should recognize the risk factors of blood transfusion therapy in PPH patients as soon as possible, such as placenta previa, placental abruption, placenta conglutination, implanted placenta, residual placenta, uterine inertia and coagulation dysfunction and so on, and evaluate the risk of postpartum hemorrhage in time, and then provide timely and effective treatment and give active treatment of anemia during pregnancy. When the PPH patients should receive massive transfusion therapy, FFP and blood platelets should be transfused early to reduce the incidence of coagulation disorders and maternal mortality rate. Key words: Postpartum hemorrhage; Placenta previa; Obstetrics blood transfusion therapy; Massive transfusion