Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan.
Center for Transfusion Medicine and Cell Therapy, Keio University School of Medicine, Tokyo 160-8582, Japan.
Medicina (Kaunas). 2021 Sep 18;57(9):983. doi: 10.3390/medicina57090983.
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. We retrospectively reviewed the etiology of PPH, transfusion outcomes, and laboratory findings among the patients treated with MTP after delivery in our hospital. 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. 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.
产后大出血（PPH）是全球范围内导致产妇死亡的最常见原因。大量输血方案（MTP）可能在 PPH 的管理中提供显著益处；然而，只有少数医院使用 MTP 方案来管理大量产科出血，尤其是在日本。本研究旨在评估我们医院使用 MTP 治疗产后患者的临床结局。
我们回顾性地分析了我们医院使用 MTP 治疗的患者的 PPH 病因、输血结局和实验室检查结果。MTP 在 24 例（0.7%的分娩）中得到应用。其中，15 例（62.5%）在分娩后 2 小时内激活了 MTP。中位估计出血量为 5017 毫升。为控制出血，19 例患者进行了其他处理，包括经动脉栓塞术（18 例，75%）和子宫切除术（1 例，4.2%）。红细胞、新鲜冷冻血浆和血小板的平均用量分别为 17.9、20.2 和 20.4 单位。红细胞、新鲜冷冻血浆、血小板、出血量和产科弥散性血管内凝血评分之间的任何两个项目的相关系数范围为 0.757 至 0.892，表明相关系数水平较高。尽管在发生 PPH 时，纤维蛋白原<150mg/dL 组的凝血酶原时间和活化部分凝血活酶时间水平明显高于纤维蛋白原≥150mg/dL 组，但两组的出血量和输血量相当。
我们的 MTP 为发生严重 PPH 的患者提供了早期获得血液制品的途径，并有助于改善我们医院复苏后的产妇结局。我们的研究表明，实施医院特定的 MTP 方案可以改善医生管理大量产科出血时血液制品的供应和利用。
