Clinical Results of a Massive Blood Transfusion Protocol for Postpartum Hemorrhage in a University Hospital in Japan: A Retrospective Study
<i>Background and objectives</i><i>:</i> Massive postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide. A massive transfusion protocol (MTP) may be used to provide significant benefits in the management of PPH; however, only a limited number of hosp...
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doaj-11652f295bd64e848801280be872ea552021-09-26T00:39:48ZengMDPI AGMedicina1010-660X1648-91442021-09-015798398310.3390/medicina57090983Clinical Results of a Massive Blood Transfusion Protocol for Postpartum Hemorrhage in a University Hospital in Japan: A Retrospective StudyDaigo Ochiai0Yushi Abe1Rie Yamazaki2Tomoe Uemura3Ayako Toriumi4Hiroko Matsuhashi5Yuya Tanaka6Satoru Ikenoue7Yoshifumi Kasuga8Ryuji Tanosaki9Mamoru Tanaka10Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, JapanDepartment of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, JapanCenter for Transfusion Medicine and Cell Therapy, Keio University School of Medicine, Tokyo 160-8582, JapanCenter for Transfusion Medicine and Cell Therapy, Keio University School of Medicine, Tokyo 160-8582, JapanCenter for Transfusion Medicine and Cell Therapy, Keio University School of Medicine, Tokyo 160-8582, JapanCenter for Transfusion Medicine and Cell Therapy, Keio University School of Medicine, Tokyo 160-8582, JapanDepartment of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, JapanDepartment of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, JapanDepartment of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, JapanCenter for Transfusion Medicine and Cell Therapy, Keio University School of Medicine, Tokyo 160-8582, JapanDepartment of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan<i>Background and objectives</i><i>:</i> Massive postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide. A massive transfusion protocol (MTP) may be used to provide significant benefits in the management of PPH; however, only a limited number of hospitals use MTP protocol to manage massive obstetric hemorrhages, especially in Japan. This study aimed to assess the clinical outcomes in patients in whom MTP was activated in our hospital. <i>Materials and Methods:</i> We retrospectively reviewed the etiology of PPH, transfusion outcomes, and laboratory findings among the patients treated with MTP after delivery in our hospital. <i>Results:</i> MTP was applied in 24 cases (0.7% of deliveries). Among them, MTP was activated within 2 h of delivery in 15 patients (62.5%). The median estimated blood loss was 5017 mL. Additional procedures to control bleeding were performed in 19 cases, including transarterial embolization (18 cases, 75%) and hysterectomy (1 case, 4.2%). The mean number of units of red blood cells, fresh frozen plasma, and platelets were 17.9, 20.2, and 20.4 units, respectively. The correlation coefficients of any two items among red blood cells, fresh frozen plasma, platelets, blood loss, and obstetrical disseminated intravascular coagulation score ranged from 0.757 to 0.892, indicating high levels of correlation coefficients. Although prothrombin time and activated partial thromboplastin time levels were significantly higher in the <150 mg/dL fibrinogen group than in the ≥150 mg/dL fibrinogen group at the onset of PPH, the amount of blood loss and blood transfusion were comparable between the two groups. <i>Conclusions:</i> Our MTP provides early access to blood products for patients experiencing severe PPH and could contribute to improving maternal outcomes after resuscitation in our hospital. Our study suggests the implementation of a hospital-specific MTP protocol to improve the supply and utilization of blood products to physicians managing major obstetric hemorrhage.https://www.mdpi.com/1648-9144/57/9/983postpartum hemorrhagemassive blood transfusion protocoldelivery |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Daigo Ochiai Yushi Abe Rie Yamazaki Tomoe Uemura Ayako Toriumi Hiroko Matsuhashi Yuya Tanaka Satoru Ikenoue Yoshifumi Kasuga Ryuji Tanosaki Mamoru Tanaka |
spellingShingle |
Daigo Ochiai Yushi Abe Rie Yamazaki Tomoe Uemura Ayako Toriumi Hiroko Matsuhashi Yuya Tanaka Satoru Ikenoue Yoshifumi Kasuga Ryuji Tanosaki Mamoru Tanaka Clinical Results of a Massive Blood Transfusion Protocol for Postpartum Hemorrhage in a University Hospital in Japan: A Retrospective Study Medicina postpartum hemorrhage massive blood transfusion protocol delivery |
author_facet |
Daigo Ochiai Yushi Abe Rie Yamazaki Tomoe Uemura Ayako Toriumi Hiroko Matsuhashi Yuya Tanaka Satoru Ikenoue Yoshifumi Kasuga Ryuji Tanosaki Mamoru Tanaka |
author_sort |
Daigo Ochiai |
title |
Clinical Results of a Massive Blood Transfusion Protocol for Postpartum Hemorrhage in a University Hospital in Japan: A Retrospective Study |
title_short |
Clinical Results of a Massive Blood Transfusion Protocol for Postpartum Hemorrhage in a University Hospital in Japan: A Retrospective Study |
title_full |
Clinical Results of a Massive Blood Transfusion Protocol for Postpartum Hemorrhage in a University Hospital in Japan: A Retrospective Study |
title_fullStr |
Clinical Results of a Massive Blood Transfusion Protocol for Postpartum Hemorrhage in a University Hospital in Japan: A Retrospective Study |
title_full_unstemmed |
Clinical Results of a Massive Blood Transfusion Protocol for Postpartum Hemorrhage in a University Hospital in Japan: A Retrospective Study |
title_sort |
clinical results of a massive blood transfusion protocol for postpartum hemorrhage in a university hospital in japan: a retrospective study |
publisher |
MDPI AG |
series |
Medicina |
issn |
1010-660X 1648-9144 |
publishDate |
2021-09-01 |
description |
<i>Background and objectives</i><i>:</i> Massive postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide. A massive transfusion protocol (MTP) may be used to provide significant benefits in the management of PPH; however, only a limited number of hospitals use MTP protocol to manage massive obstetric hemorrhages, especially in Japan. This study aimed to assess the clinical outcomes in patients in whom MTP was activated in our hospital. <i>Materials and Methods:</i> We retrospectively reviewed the etiology of PPH, transfusion outcomes, and laboratory findings among the patients treated with MTP after delivery in our hospital. <i>Results:</i> MTP was applied in 24 cases (0.7% of deliveries). Among them, MTP was activated within 2 h of delivery in 15 patients (62.5%). The median estimated blood loss was 5017 mL. Additional procedures to control bleeding were performed in 19 cases, including transarterial embolization (18 cases, 75%) and hysterectomy (1 case, 4.2%). The mean number of units of red blood cells, fresh frozen plasma, and platelets were 17.9, 20.2, and 20.4 units, respectively. The correlation coefficients of any two items among red blood cells, fresh frozen plasma, platelets, blood loss, and obstetrical disseminated intravascular coagulation score ranged from 0.757 to 0.892, indicating high levels of correlation coefficients. Although prothrombin time and activated partial thromboplastin time levels were significantly higher in the <150 mg/dL fibrinogen group than in the ≥150 mg/dL fibrinogen group at the onset of PPH, the amount of blood loss and blood transfusion were comparable between the two groups. <i>Conclusions:</i> Our MTP provides early access to blood products for patients experiencing severe PPH and could contribute to improving maternal outcomes after resuscitation in our hospital. Our study suggests the implementation of a hospital-specific MTP protocol to improve the supply and utilization of blood products to physicians managing major obstetric hemorrhage. |
topic |
postpartum hemorrhage massive blood transfusion protocol delivery |
url |
https://www.mdpi.com/1648-9144/57/9/983 |
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