An Analysis of Large Volume Blood and Blood Product Transfusion in Critically Ill Obstetric Patients: A Retrospective Study

JOURNAL TITLE: Journal of South Asian Federation of Obstetrics and Gynaecology

Author
1. Nitin Raithatha
2. Smruti B Vaishnav
3. Vishal Sheth
4. Rumi Bhattacharjee
5. Shilpa Sapre
ISSN
0974-8938
DOI
10.5005/jp-journals-10006-1670
Volume
11
Issue
3
Publishing Year
2019
Pages
5
Author Affiliations
    1. Department of Obstetrics and Gynaecology, SK Hospital and Pramukhswami Medical College, Anand, Gujarat, India
    1. Department of Obstetrics and Gynecology, Pramukhswami Medical College, Karamsad, Gujarat, India
    1. SAIMS, Indore, Madhya Pradesh, India
    1. Department of Obstetrics and Gynecology, Pramukhswami Medical College, Karamsad, Gujarat, India
    1. Department of Obstetrics and Gynaecology, Pramukhswami Medical College, Anand, Gujarat, India
  • Article keywords
    Massive blood transfusion, Maternal mortality, Postpartum hemorrhage, Severe obstetric hemorrhage

    Abstract

    Objectives: (1) To study the clinical profile of patients requiring massive blood transfusion (≥4 units). (2) To study the pattern of component requirement in these patients. (3) To study the maternal and fetal outcome. Materials and methods: Design: It is a retrospective database analysis over 2.5 years from January 2014 to June 2017. Setting: Rural tertiary care center in Anand, Gujarat, India. Population/sample: Cases with severe obstetric hemorrhage requiring acute transfusion ≥4 units were included. Samples size is 69. Data were obtained from the medical record department. Parameters analyzed were demographic and obstetric profile, transfusion and laboratory data, adverse maternal and neonatal outcome, data pertaining to intensive care unit (ICU), critical surgical intervention, and complications. Statistical analysis was done using Stata 14. Results: Of total 2619 institutional deliveries and 185 postpartum women referred from outside in the study period, 69 patients required large volume blood transfusion (2.4%). 95% were referred from the government and private setups. Postpartum hemorrhage (PPH) was the leading cause of hemorrhage with high case fatality index and maximum blood product consumption. p value = 0.0033 (nonparametric test). 76.8% required ICU admission and 40.5% required ventilatory support. 23% underwent peripartum hysterectomy. Maternal mortality occurred in 10% patients. Conclusion: Major blood loss in obstetric practice is the leading cause of maternal morbidity and mortality. Improper transfusion practices contribute to a lot of avoidable complications. Rapid recognition of anticipated and unanticipated hemorrhage, early aggressive hemostatic resuscitation, and multidisciplinary intervention can ensure optimal fetomaternal outcome.

    © 2019 Jaypee Brothers Medical Publishers (P) LTD.   |   All Rights Reserved