Online first
Research paper
Published online: 2022-03-21

open access

Page views 1153
Article views/downloads 660
Get Citation

Connect on Social Media

Connect on Social Media

Life-threatening postpartum hemorrhage (≥ 5000 mL): a single center experience

Xiao Yue Guo123, Yan Zhang123, Yang Yu Zhao123

Abstract

Objectives: To investigate the etiology, interventions and outcome of life-threatening postpartum hemorrhage (PPH) (≥ 5000 mL).

Material and methods: Retrospective analysis was performed on the clinical data of 42 patients with life-threatening PPH in Peking University Third Hospital from January 2010 to December 2019. According to the causes of PPH, 35 patients were divided into the placenta accrete spectrum (PAS) group and seven patients into the uterine atony group.

Results: Compared with the uterine atony group, the gravidity, parity, times of cesarean section, abortion and intrauterine operation of the PAS group were significantly higher, but the gestational age of delivery and the birth weight of newborn were significantly lower (33.35 ± 3.94 weeks vs 37.31 ± 1.93 weeks; 2228.29 ± 840.49 g vs 2809.00 ± 500.99 g; p < 0.05). For all the patients, the transfusion volume of packed red blood cell (PRBCs), fresh frozen plasma (FFP) and platelets were respectively 23.49 ± 8.42 U, 2345.24 ± 826.16 mL and 0.81 ± 1.19 U, the ratio was basically conformed to the recommended massive transfusion protocol (MTP) (1:1:1). The catheter placement time in the PAS group was significantly longer (7.88 ± 6.05 days vs 3.86 ± 0.90 days, p < 0.05). There were no significant differences in complications and maternal outcomes. No maternal deaths.

Conclusions: Placenta accrete spectrum (PAS) is the most important cause of life-threatening PPH. For these patients, MTP is effective, multidisciplinary cooperation and management lead to a good prognosis.

Article available in PDF format

View PDF Download PDF file

References

  1. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014; 384(9947): 980–1004.
  2. Varatharajan L, Chandraharan E, Sutton J, et al. Outcome of the management of massive postpartum hemorrhage using the algorithm "HEMOSTASIS". Int J Gynaecol Obstet. 2011; 113(2): 152–154.
  3. Vogel JP, Oladapo OT, Dowswell T, et al. Updated WHO recommendation on intravenous tranexamic acid for the treatment of post-partum haemorrhage. Lancet Glob Health. 2018; 6(1): e18–e19.
  4. Evensen A, Anderson JM, Fontaine P. Postpartum Hemorrhage: Prevention and Treatment. Am Fam Physician. 2017; 95(7): 442–449.
  5. Tunçalp O, Souza JP, Gülmezoglu M, et al. World Health Organization. New WHO recommendations on prevention and treatment of postpartum hemorrhage. Int J Gynaecol Obstet. 2013; 123(3): 254–256.
  6. Main EK, Goffman D, Scavone BM, et al. National Partnership for Maternal Safety, Council on Patient Safety in Women's Health Care. National Partnership for Maternal Safety: Consensus Bundle on Obstetric Hemorrhage. Obstet Gynecol . 2015; 126(1): 155–162.
  7. Dahlke JD, Mendez-Figueroa H, Maggio L, et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol. 2015; 213(1): 76.e1–76.e10.
  8. Sentilhes L, Vayssière C, Deneux-Tharaux C, et al. Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). Eur J Obstet Gynecol Reprod Biol. 2016; 198: 12–21.
  9. Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52. BJOG. 2017; 124(5): e106–e149.
  10. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017; 130(4): e168–e186.
  11. Muñoz M, Stensballe J, Ducloy-Bouthors AS, et al. Patient blood management in obstetrics: prevention and treatment of postpartum haemorrhage. A NATA consensus statement. Blood Transfus. 2019; 17(2): 112–136.
  12. B-Lynch CA. A Comprehensive Textbook of Postpartum Hemorrhage: An Essential Clinical Reference for Effective Management 2nd Edition. Sapiens Publishing, London 2012.
  13. Quantitative Blood Loss in Obstetric Hemorrhage: ACOG COMMITTEE OPINION SUMMARY, Number 794. Obstet Gynecol. 2019; 134(6): 1368–1369.
  14. Chong Y, Zhang A, Wang Y, et al. An ultrasonic scoring system to predict the prognosis of placenta accreta: A prospective cohort study. Medicine (Baltimore). 2018; 97(35): e12111.
  15. Marr L, Lennox C, McFadyen AK. Quantifying severe maternal morbidity in Scotland: a continuous audit since 2003. Curr Opin Anaesthesiol. 2014; 27(3): 275–281.
  16. Belfort MA. Publications Committee, Society for Maternal-Fetal Medicine. Placenta accreta. Am J Obstet Gynecol. 2010; 203(5): 430–439.
  17. Jauniaux E, Jurkovic D. Placenta accreta: pathogenesis of a 20th century iatrogenic uterine disease. Placenta. 2012; 33(4): 244–251.
  18. Silver RM, Landon MB, Rouse DJ, et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006; 107(6): 1226–1232.
  19. Allen L, Jauniaux E, Hobson S, et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management. Int J Gynaecol Obstet. 2018; 140(3): 281–290.
  20. Pasquier P, Gayat E, Rackelboom T, et al. An observational study of the fresh frozen plasma: red blood cell ratio in postpartum hemorrhage. Anesth Analg. 2013; 116(1): 155–161.
  21. Saule I, Hawkins N. Transfusion practice in major obstetric haemorrhage: lessons from trauma. Int J Obstet Anesth. 2012; 21(1): 79–83.
  22. Collins P, Abdul-Kadir R, Thachil J. Management of coagulopathy associated with postpartum hemorrhage: guidance from the SSC of the ISTH. J Thromb Haemost. 2016; 14(1): 205–210.
  23. Jones RM, de Lloyd L, Kealaher EJ, et al. collaborators. Platelet count and transfusion requirements during moderate or severe postpartum haemorrhage. Anaesthesia. 2016; 71(6): 648–656.
  24. Singh K, Gupta R, Kamal H, et al. Posterior reversible encephalopathy syndrome secondary to blood transfusion. J Clin Neurosci. 2015; 22(3): 592–594.
  25. Ouh YT, Lee KM, Ahn KiH, et al. Predicting peripartum blood transfusion: focusing on pre-pregnancy characteristics. BMC Pregnancy Childbirth. 2019; 19(1): 477.