Transfusion management of obstetric patients with massive hemorrhage
CCCF ePoster library. Parker A. Oct 3, 2017; 198221; 61
Dr. Arabesque Parker
Dr. Arabesque Parker
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Transfusion management of obstetric patients with massive hemorrhage

Arabesque Parker1 MD FRCPC, Heather Blain2 BSc, Susan Nahirniak2.3 MD FRCPC


1 Department of Critical Care, University of Alberta, Edmonton, Canada

2 Alberta Health Services, Edmonton Zone, Canada

3 Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada


Obstetrical hemorrhage is the leading cause of maternal mortality worldwide, and the most common reason for obstetrical patients to be admitted to the intensive care unit.  Low maternal fibrinogen levels are associated with severe hemorrhage (1) and rapid restoration with reduced blood loss (2).
The objective of this study was to assess delay of treatment of hypofibrinogenemia in obstetrical patients who have a massive hemorrhage protocol (MHP) initiated. This was defined as patients with an initial fibrinogen ≤ 2.0 not receiving a fibrinogen containing product prior to or with the first package from the MHP.  Secondary outcomes include 30-day mortality and blood product wastage.
Data were retrospectively collected on all consecutive obstetrical patients for whom a MHP was initiated in five hospitals in Edmonton, Canada from July 2012 and September 2016. Patient demographics, laboratory data, and 30-day mortality were collected. Blood component usage and wastage were collected for the duration of MHP as well as 24 hours pre and post.
A total of 97 patients were included.  Mean age was 32 (±6 SD), mean duration of MHP was 3.4 hours (±2.2 SD). The median unit usage of red cells was 10 (IQR 5, 14.5), plasma 4 (IQR 2,7), platelets 1 (IQR 0,2), Table 1. For patients who received both RBC and plasma, the mean red cell to plasma ratio = 2.43, (±1.44 SD). Two patients received recombinant factor VIIa.  The majority of patients (66%) received a fibrinogen containing product, with 32% receiving only cryoprecipitate, 15% receiving only fibrinogen concentrate, and 19% receiving both. 51% of patients received ≥ 10 red cell units, these patients had higher initial PTT (59 vs 41, p = 0.013) and lower initial fibrinogen (1.6 vs. 2.4, p = 0.03).  Of patients presenting with hypofibrinogenemia, 39% experienced a delay in fibrinogen replacement.  Those with a delay experienced a trend to higher blood product use, (red cells 16.1 vs 12.7, p = 0.27, plasma 9.0 vs 6.3, p = 0.19). Blood product wastage occurred in 24% of MHP (7% RBC wastage, 16% plasma wastage, and 2% cryoprecipitate wastage).  30-day mortality was 2.1%. 
Among bleeding obstetrical patients who have a MHP initiated, a large proportion of patients with hypofibrinogenemia experienced a delay in fibrinogen replacement. These findings suggest that alterations to the management of obstetrical hemorrhage to address this delay in fibrinogen replacement may be useful.  

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