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

Abstract

Introduction: Peripartum hemorrhage is a major complication
requiring emergency transfusion of packed blood or its
components with quick decision-making. We describe
our experience of transfusion practices in major obstetric
hemorrhage.
Materials and Methods: Retrospective observational data
of all the deliveries (n = 1837) over period of one year.
All cases were assessed for obstetric hemorrhage and
subsequent transfusion practices done. Demographic details,
obstetric history, indications for transfusion, gestational age
at transfusion, pre- and post-transfusion hemoglobin levels,
nature and type of transfusion, units of transfusion, adverse
events following transfusion and outcome in terms of morbidity
and mortality were noted. Data was analyzed using SPSS 21.0
software. Chi-square test was used for analysis.
Results: Transfusion was required in 776 (42.2%) pregnant
women. Obstetric hemorrhage was the indication in 432 (55.7%)
of the women receiving a transfusion. Other indications were
anemia 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 significant
change seen. A total of 138/432 (31.9%) cases had pretransfusion
hemoglobin level <8 g/dl in cases of moderate
anemia. PRBC was transfused to 319 (73.8%) followed by
platelets (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 noted
in 32 (7.4%) cases. There were 6 (1.4%) mortalities (all having
pre-transfusion Hb <6 g/dl).
Conclusion: The study highlighted the significance of packed
blood cells and component transfusion in reducing obstetric
morbidity and mortality