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The incidence, aetiology, and coagulation management of massive postpartum haemorrhage: a two-year national prospective cohort study

Bell, S. F., Collis, R. E., Bailey, C., James, K., John, M., Kelly, K., Kitchen, T., Scarr, C., Macgillivray, E. and Collins, P. W. 2021. The incidence, aetiology, and coagulation management of massive postpartum haemorrhage: a two-year national prospective cohort study. International Journal of Obstetric Anesthesia 47 , 102983. 10.1016/j.ijoa.2021.102983

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Abstract

Introduction Between 2017 and 2018 a national quality improvement initiative was introduced incorporating point-of-care viscoelastic haemostatic assays (VHA) to guide blood product transfusion. Laboratory coagulation profiles, use and results of VHA, and administration of blood products were investigated. Methods A two-year prospective cohort study of maternal outcomes of women experiencing massive postpartum haemorrhage (PPH) >1000 mL in Wales. In this study, cases of massive PPH (≥2500 mL and/or ≥5 units red blood cell (RBC) transfusion) were identified. Results Massive PPH occurred in 349 of 60 914 maternities (rate 5.7 per 1000). There were no deaths from PPH. Intensive care unit admission and/or hysterectomy occurred in 34/311 (10.9%) and 16/347 (4.6%), respectively. The leading cause of massive PPH was genital tract trauma (107/349, 30.6%). Two hundred and seventy-nine (80.6%) required RBC transfusion and 79/345 (22.9%) received at least one blood coagulation product. Results of VHA were recorded in 245/349 (70.2%), with 44/98 (44.9%) women tested in the first six months vs 63/77 (81.8%) in the final six months. Hypofibrinogenaemia (Clauss fibrinogen <2 g/L or FIBTEM A5 <12 mm) was observed in 56/328 (17.1%) of women, thrombocytopaenia (count <75 × 109/L) in 17/334 (5.1%) and either PT or aPTT >1.5×reference range in 10/293 (3.4%). Conclusion In Wales, the use of VHA in cases of massive PPH increased over time, enabling clinicians to adopt a targeted, patient-specific approach to blood product administration, with only 22.9% of women receiving blood coagulation products and 17.1% having a documented clotting abnormality.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Elsevier
ISSN: 0959-289X
Date of First Compliant Deposit: 16 August 2021
Date of Acceptance: 14 March 2021
Last Modified: 16 May 2022 15:56
URI: https://orca.cardiff.ac.uk/id/eprint/143442

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