Haematological features, transfusion management and outcomes of massive obstetric haemorrhage: findings from the Australian and New Zealand Massive Transfusion Registry. (16th February 2020)

• Record Type: Journal Article
• Authors: Lasica, Masa; Sparrow, Rosemary L.; Tacey, Mark; Pollock, Wendy E.; Wood, Erica M.; McQuilten, Zoe K.
• Is Part Of: British journal of haematology. Volume 190:Number 4(2020)
• Page Start: 618
• Page End: 628
• Publication Date: 2020-02-16
• Subjects: obstetric haemorrhage -- massive transfusion -- coagulopathy -- fibrinogen; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; 616.15
• DOI: 10.1111/bjh.16524
• Languages: English
• ISSNs: 0007-1048

Abstract

Summary: Massive obstetric haemorrhage (MOH) is a leading cause of maternal morbidity and mortality world‐wide. Using the Australian and New Zealand Massive Transfusion Registry, we performed a bi‐national cohort study of MOH defined as bleeding at ≥20 weeks' gestation or postpartum requiring ≥5 red blood cells (RBC) units within 4 h. Between 2008 and 2015, we identified 249 cases of MOH cases from 19 sites. Predominant causes of MOH were uterine atony (22%), placenta praevia (20%) and obstetric trauma (19%). Intensive care unit admission and/or hysterectomy occurred in 44% and 29% of cases, respectively. There were three deaths. Hypofibrinogenaemia (<2 g/l) occurred in 52% of cases in the first 24 h after massive transfusion commenced; of these cases, 74% received cryoprecipitate. Median values of other haemostatic tests were within accepted limits. Plasma, platelets or cryoprecipitate were transfused in 88%, 66% and 57% of cases, respectively. By multivariate regression, transfusion of ≥6 RBC units before the first cryoprecipitate (odds ratio [OR] 3·5, 95% CI: 1·7–7·2), placenta praevia (OR 7·2, 95% CI: 2·0–26·4) and emergency caesarean section (OR 4·9, 95% CI: 2·0–11·7) were independently associated with increased risk of hysterectomy. These findings confirm MOH as a major cause of maternal morbidity and mortality and indicate areas for practice improvement.