title: The haematological features and transfusion management of women who required massive transfusion for major obstetric haemorrhage in the UK: a population based study.
abstract: Understanding the coagulopathy of major-obstetric-haemorrhage (MOH) that leads to massive-transfusion (MT) is fundamental to improving outcomes. This study reports on the haematological features and transfusion management of women experiencing MT [defined as transfusion of ≥8 units of red blood cells (RBC) within 24 h of delivery]. One hundred and eighty-one cases [median (interquartile range; IQR) age 33 years (29-36)] were identified from all UK hospitals, using the UK Obstetric Surveillance System between July 2012 and June 2013. The median (IQR) estimated blood loss was 6 l (4·5-8). At presentation, the median platelet count was lowest for placenta accreta, compared with other causes, while the median prothrombin time and fibrinogen were <1·5 × mean normal and <3 g/l, respectively for all aetiologies. Median platelet count and fibrinogen fell to <75 × 10(9) /l and <2 g/l, respectively for all causes during bleeding, except for trauma. The median (IQR) units of RBC, fresh-frozen-plasma (FFP) and cryoprecipitate transfused were 10 (8-14), 6 (4-8) and 2 (2-4), respectively. The median time from the onset of bleeding to delivery of the first RBC unit was significantly shorter for women who delivered via elective caesarean section, compared with others. The coagulopathy of MT during MOH differs significantly depending on its cause, suggesting that more targeted transfusion strategies are required.
authors.affiliation: Barts Health NHS Trust & NHS Blood and Transplant, London, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Green
authors.affiliation: National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
authors.forename: Marian
authors.initials: M
authors.lastname: Knight
authors.affiliation: Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK.
authors.forename: Frances
authors.initials: F
authors.lastname: Seeney
authors.affiliation: Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK.
authors.forename: Cathy
authors.initials: C
authors.lastname: Hopkinson
authors.affiliation: Arthur Bloom Haemophilia Centre, Cardiff University, Cardiff, UK.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Collins
authors.affiliation: Department of Anaesthetics, Cardiff and Vale University Health Board, Cardiff, UK.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Collis
authors.affiliation: Department of Women's and Children's Health, University of Leeds, Leeds, UK.
authors.forename: Nigel A B
authors.initials: NA
authors.lastname: Simpson
authors.affiliation: Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Weeks
authors.affiliation: NHS Blood and Transplant, Oxford & Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Stanworth
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005440:Fluid Therapy / Q000379:methods; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000628:therapy*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology*; D011517:Prothrombin Time; D012189:Retrospective Studies; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D006454:Hemoglobins; D005340:Fibrinogen
keywords: coagulopathy; massive transfusion; obstetric haemorrhage; outcomes; transfusion management