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Major Obstetric Haemorrhage Audit: A Worthwhile Exercise
Abstract Number: T5B-6
Abstract Type: Original Research
Major obstetric haemorrhage (MOH) remains a common and demanding clinical emergency requiring multi-disciplinary teamwork to facilitate simultaneous resuscitation and management. MOH guidelines are instituted for blood loss greater than 1.5litres or where the patient is unstable. The Massive Haemorrhage Protocol (MHP) is activated for ongoing blood loss and cardiovascular instability, and facilitates timely and rapid provision of blood component packs.
Audit data was collected and reviewed monthly by a multi-disciplinary committee over a 12 month period at a tertiary maternity hospital (9000 deliveries/year). MOH was defined as estimated blood loss (EBL) >1.5litres. Patients with underlying coagulation disorders or pregnancies <24weeks gestation were excluded from analysis.
99 parturients had a recognised MOH with EBL >1.5litres (range 1.5-8.6litres, median 2.32litres). 46% were primiparous, and 19 were IVF pregnancies. 53% had lower segment caesarean sections, 26% spontaneous vaginal delivery and 21% instrumental delivery. Contributing causes with overlap were atony (50%), trauma (34%), retained products of conception (17%), infection (11%), and placenta accreta (9%). Hysterectomy occurred in 8 patients.
Eighteen cases had MHP pathway activated with release of MHP blood product packs in 2017. Red blood cell (RBC) transfusion occurred in 100% of MHP cases (range 1-12 units, median 4 units). O negative RBC was transfused in 50% of cases (range 1 – 8 units). Plasma was transfused in 78% (median 3 units, range 1-10 units), and platelets were transfused in 8 cases (median 1.5pools, range 1-6 pools). Fibrinogen was transfused in 88% of cases (median 2g, range 2-11g) and 100% of cases received tranexamic acid (median 1g, range 1-2g). Overall emergency O negative RBC use fell from 34% in 2016 to 16% in 2017. This was attributed to education on safe use of group suitable RBC, improved time for availability of RBC and reduction of immediate supply of O negative units in theatre.
Audits of obstetric haemorrhage and transfusion practice has resulted in reduction in use of limited supply O negative RBC and reduction in product wastage without compromising resuscitation. Envisaged introduction of viscoelastic point of care testing and continued audit aspires to further improve transfusion therapy.
Butwick AJ et al; Curr Opin Anesthesiol 2015(3)275-84
Ducloy-Bouthors et al; Anaes Analg 2014;119(5)1140-1147