Global Journal of Transfusion Medicine (Jan 2018)
A study on transfusion practice in obstetric hemorrhage in a tertiary care centre
Abstract
Context: Blood Transfusion is identified as one of the essential components of comprehensive emergency obstetric care which has drastically reduced the maternal mortality. Aims: This study retrospectively reviewed blood transfusion pattern in patients with obstetric hemorrhage in our tertiary care center Government Medical College, Trivandrum (Sree Avittam Thirunal is a part of Government Medical College, Trivandrum) and analyzed the obstetric indications and risk factors for transfusion. We also analyzed the ratio of components transfused. Materials and Methods: Transfusion request forms of 310 patients admitted to the Department of Gynaecology and Obstetrics in Sree Avittom Thirunal Hospital from January 2013 to May 2013 were retrospectively reviewed for the types and volume of blood component transfused indication for each blood component transfusion noted. Patients who had massive obstetric hemorrhage (MOH) were further analyzed to estimate the ratio of components transfused. Statistical Analysis: Chi-square test (for categorical variables) was done to assess frequency distribution. Logistic regression analysis was done to identify major risk factors. The analysis was done using SPSS version 16. P < 0.05 was considered to indicate statistically significant. Results: We have experienced 299 obstetric patients who underwent blood component transfusion during the study. 73% (218) and 27% (81) cases needed peripartum and antepartum transfusion, respectively. Anemia correction accounted for the maximum cases in antepartum transfusion. The leading obstetric conditions of intrapartum and postpartum hemorrhage include abruptio placenta (51 cases; 23.4%), atonic postpartum hemorrhage (30 cases; 13.8%), placenta previa (54 cases; 24.8%), and uterine inversion (15 cases; 6.9%). About 87.2% received packed red blood cell transfusion and 43.7% received platelet concentrate transfusion. 48.1% received fresh frozen plasma (FFP) transfusion. Only 14.2% (21) were transfused with cryoprecipitate. Nearly 27.4% (82) of study individuals had MOH. 92.35% of cases with MOH received FFP transfusion. Cryoprecipitate transfusion was given to 5.4% (15) of patients with MOH. Significant risk factors for MOH, identified using a multivariable analysis, were placenta previa (OR 20.7, 95%CI 9.6–44.6); abruptio placenta (odds ratio [OR]: 3.4, 95% confidence interval [CI]: 1.2–3.7); atonic postpartum hemorrhage (OR: 1.4, 95% CI: 1.1–3.4); uterine inversion (OR: 1.2, 95% CI: 1.0–1.8); and rupture uterus (OR: 1.84, 95% CI: 1.1–2.4). A significant positive correlation was observed between the number of units of red cell concentrate (RCC) and that of FPP (P < 0.001). The median of FFP/RCC ratio for each patient was 1.42. Conclusions: A preplanned, multidisciplinary protocol yields the best results in the management of obstetric hemorrhage. In conclusion, for MOH where appropriate supplementation of coagulation factors is essential, the transfusion practice of RCC and FFP in the ratio of 1:1.4–2 observed in our institution is acceptable. However, the utilization of cryoprecipitate needs to be improved.
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