To study the Transfusion Practice with respect to Component Therapy in Major Obstetric Hemorrhage

Abstract

Introduction: Peripartum hemorrhage is a major complicationrequiring emergency transfusion of packed blood or itscomponents with quick decision-making. We describeour experience of transfusion practices in major obstetrichemorrhage.Materials and Methods: Retrospective observational dataof all the deliveries (n = 1837) over period of one year.All cases were assessed for obstetric hemorrhage andsubsequent transfusion practices done. Demographic details,obstetric history, indications for transfusion, gestational ageat transfusion, pre- and post-transfusion hemoglobin levels,nature and type of transfusion, units of transfusion, adverseevents following transfusion and outcome in terms of morbidityand mortality were noted. Data was analyzed using SPSS 21.0software. Chi-square test was used for analysis.Results: Transfusion was required in 776 (42.2%) pregnantwomen. Obstetric hemorrhage was the indication in 432 (55.7%)of the women receiving a transfusion. Other indications wereanemia during pregnancy (39.7%) and traumatic pph (10.5%),respectively. Among major obstetric hemorrhage cases (n =432), the majority (n = 224; 51.9%) had antepartum hemorrhage(abruptio placentae/placenta previa) and the remaining 208(48.1%) had postpartum hemorrhage change no significantchange seen. A total of 138/432 (31.9%) cases had pretransfusionhemoglobin level <8 g/dl in cases of moderateanemia. PRBC was transfused to 319 (73.8%) followed byplatelets (212; 49.1%) and FFP (n = 29; 6.7%), respectively.The majority of cases required only 2 units of transfusion.There were 21 (4.9%) cases requiring more than 3 units.Post-transfusion hemoglobin levels were >10 g/dl in 319/432(73.8%) cases, thus showing a significant change (p < 0.05).Most common adverse reactions (fever/shivering) were notedin 32 (7.4%) cases. There were 6 (1.4%) mortalities (all havingpre-transfusion Hb <6 g/dl).Conclusion: The study highlighted the significance of packedblood cells and component transfusion in reducing obstetricmorbidity and mortality