Background and Goal of Study:

Severe postpartum haemorrhage is still the leading cause of maternal morbidity also in high-income countries. Implementation of new treatment strategies of early antifibrinolytic agent and fibrinogen concentrate administration together with new surgical and angiological techniques may already have made a difference. We investigated how transfusion, fluid and medical therapy have changed over six years and whether these changes have had an effect on total blood loss and transfusion requirements, incidence of massive bleedings and transfusions, intensive care admissions and morbidity.

Materials and Methods:

All severe postpartum haemorrhage (≥1500 ml) cases (n=1141) in 2009-2015 were identified from a tertiary hospital’s computerized database. Their background, long-term illnesses, medication, pregnancy and delivery data, data on treatment of bleeding, laboratory values, intensive care admissions and possible complications were recorded. SPSS version 23 was used for statistical analyses: Kruskal-Wallis test was used to compare medians of different numerical variables grouped by each year studied and Chi-Square test or logistic regression analysis was used for binominal variables to examine the significance of changes from year to another.

Results and Discussion:

Numbers of massive bleedings (≥5000ml) and massive transfusions (≥10 units of red blood cells in 24 hours) decreased during the study period (5,2⇒0,6% and 5,8⇒2,4%; p=0.005 and 0.019, respectively). Number of intensive care admissions also showed a decreasing trend (7,9⇒2,4%). Median amount of blood loss did not change significantly (p=0.629), nor the median of red cell units transfused per patient, though there was a decreasing trend. The percentage of patients receiving tranexamic acid rose from 7,8 % to 88,8% (p=0.000). A statistically non-significant rise occurred in the number of patients receiving fibrinogen concentrate (2,6⇒7,6 %). The median amount of pooled apheresis plasma units transferred per patient dropped from 4 to 2 in the last two years (p=0.014), while percentage of patients receiving it remained rather constant (16,9-24,5 %, p=0.689).

Conclusion(s):

Less massive transfusions and bleedings were seen towards the end of the study period and the median amount of plasma used per patient has dropped: the earlier and increasing use of antifibrinolytic and hemostatic agents may have contributed to this and the strategy proposed recently seems legitimized.

06 / Change in postpartum haemorrhage treatment strategy may decrease massive transfusions