medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2020, Number 10

<< Back Next >>

Ginecol Obstet Mex 2020; 88 (10)

Morbidity and mortality associated with mass transfusion protocols in severe obstetric hemorrhage

Martínez-Martínez C, Aguirre-Villanueva N, Cepeda-Nieto AC

Language: Spanish
References: 24
Page: 675-685
PDF size: 198.02 Kb.


ABSTRACT

Objective: To determine the morbidity and mortality due to the application of massive transfusion protocols in patients with obstetric hemorrhage treated in intensive care.
Materials and Methods: study of a retrospective cohort of patients with severe obstetric hemorrhage treated in the obstetric intensive care unit of the maternal and child hospital of the social security institute of the state of mexico and municipalities, between september 2014 and may 2019. three massive transfusion protocols were compared in which blood derivatives were applied in relation to the ratio of erythrocyte concentrate, platelets and plasma with the following ratios: 2:1:1, 1:1:1 and liberal. to analyze the possible association of complications with the choice of the different mass transfusion protocols, an anova and χ2 test was used in the spss version 21 program; the value of p ‹ 0.05 was considered significant.
Results: Seventy-five patients with a mean age of 32.8 years were analyzed; 63 were multigrafted. The main cause of obstetric bleeding was uterine atony. 51 of 75 of the mass transfusion protocols were liberal, 11 of them with a 2:1:1 ratio and 4 of 51 of 1:1:1. The complications were: acute respiratory failure syndrome, acute renal injury, acute renal injury originated by transfusion, infections and surgical reintervention. Positive association was found with: days of stay in intensive care (p = 0.031), surgical reintervention (p = 0.006) and acute respiratory failure syndrome (p = 0.044) and liberal mass transfusion protocols with respect to 1:1:1 ratio protocols. Only one patient died and this was associated with the liberal mass transfusion protocols.
Conclusions: The application of 1:1:1 and 2:1:1 mass transfusion protocols in patients with severe obstetric hemorrhage decreases the risk of complications. Maternal mortality due to the application of liberal mass transfusion protocols was only one case in 51 patients.


REFERENCES

  1. Sheldon W, et al. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014; 121. Suppl: 5-13. doi:10.1111/1471-0528.12636

  2. Kuruvilla S, et al. The global strategy for women’s, children’s and adolescents’ health (2016-2030): a roadmap based on evidence and country experience. Bull World Health Organ. 2016; 94 (5): 398-400. doi:10.2471/BLT.16.170431

  3. Alanís D. Informe semanal de vigilancia epidemiológica. Información relevante de muertes maternas. https:// omm.org.mx/wp-content/uploads/2020/06/BOLETINES_ 52_2019.pdf.

  4. O’Brien KL, et al. Transfusion management of obstetric hemorrhage. Transfus Med Rev. 2018; 32 (4): 249-55. doi:10.1016/j.tmrv.2018.05.003

  5. Prevención y manejo de la hemorragia postparto en primero, segundo y tercer nivel de atención. Resumen de Evidencias y Recomendaciones: Guía de Práctica clínica de enfermería. México; Secretaria de Salud, CENETEC, 2017. http://www.cenetec-difusion.com/CMGPC/SS-103-08/ ER.pdf.

  6. Ickx BE. Fluid and blood transfusion management in obstetrics. Eur J Anaesthesiol. 2010; 27 (12): 1031-35. doi:10.1097/EJA.0b013e32833c30e3

  7. Perel A. Iatrogenic hemodilution: a possible cause for avoidable blood transfusions? Crit Care. 2017; 21 (1): 291. doi:10.1186/s13054-017-1872-1

  8. Cannon JW, et al. Damage control resuscitation in patients with severe traumatic hemorrhage: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017; 82 (3): 605-17. doi:10.1097/TA.0000000000001333

  9. Rajasekhar A, et al. Survival of trauma patients after massive red blood cell transfusion using a high or low red blood cell to plasma transfusion ratio. Crit Care Med. 2011; 39 (6): 1507-13. doi:10.1097/CCM.0b013e31820eb517

  10. Ackland GL, et al. Individualized oxygen delivery targeted haemodynamic therapy in high-risk surgical patients: a multicenter, randomized, double-blind, controlled, mechanistic trial. Lancet Respir Med. 2015; 3 (1): 33-41. doi:10.1016/ S2213-2600(14)70205-X

  11. Hess JR, et al. Quality management of a massive transfusion protocol. Transfusion. 2018; 58 (2): 480-84. doi:10.1111/ trf.14443

  12. Margarido C, et al. Massive hemorrhage protocol activation in obstetrics: a 5-year quality performance review. Int J Obstet Anesth. 2019; 38: 37-45. doi:10.1016/j. ijoa.2018.10.004

  13. Pacheco LD, et al. An update on the use of massive transfusion protocols in obstetrics. Am J Obstet Gynecol. 2016; 214 (3): 340-44. doi:10.1016/j.ajog.2015.08.068

  14. Tanaka H, et al. A systematic review of massive transfusion protocol in obstetrics. Taiwan J Obstet Gynecol. 2017; 56 (6): 715-18. doi:10.1016/j.tjog.2017.10.001

  15. Clark SL, Hankins GD. Preventing maternal death: 10 clinical diamonds. Obstet Gynecol. 2012; 119 (2 Pt 1): 360-64. doi:10.1097/AOG.0b013e3182411907

  16. Mavrides E, et al. Prevention and management of postpartum haemorrhage. BJOG 2016; 124: e106-e149.

  17. Borgman MA, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007; 63 (4): 805- 13. doi: 10.1097/TA.0b013e3181271ba3

  18. Holcomb JB, et al. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients [published correction appears in Ann Surg. 2011; 253 (2): 392]. Ann Surg. 2008;248(3):447- 458. doi: 10.1097/SLA.0b013e318185a9ad

  19. Kutcher ME, et al. A paradigm shift in trauma resuscitation: evaluation of evolving massive transfusion practices. JAMA Surg. 2013; 148 (9): 834-40. doi:10.1001/ jamasurg.2013.2911

  20. Holcomb JB, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA 2015; 313 (5): 471-82. doi:10.1001/ jama.2015.12

  21. Gonzalez EA, et al. Fresh frozen plasma should be given earlier to patients requiring massive transfusion. J Trauma. 2007; 62 (1): 112-9. doi:10.1097/01. ta.0000250497.08101.8b

  22. Teofili L, et al. Acute lung injury complicating blood transfusion in post-partum hemorrhage: incidence and risk factors. Mediterr J Hematol Infect Dis. 2014; 6 (1): e2014069. doi:10.4084/MJHID.2014.069

  23. Silverboard H, et al. The role of acute blood transfusion in the development of acute respiratory distress syndrome in patients with severe trauma. J Trauma. 2005; 59 (3): 717- 23. doi: 10.1097 / 01.ta.0000174919.35240.21

  24. Guerrero-Hernández A et al. Cuidados intensivos en ginecología y obstetricia en el Hospital General de México. Rev Asoc Mex Med Crit y Ter Int 2011; 25 (4): 211-17. https:// www.medigraphic.com/pdfs/medcri/ti-2011/ti114e.pdf Consulta: abril 2020




2020     |     www.medigraphic.com