Obstetrical hemorrhage represents the single-most significant cause of maternal mortality. As hemorrhage rates increase, Massive Transfusions Protocols (MTP) have been adopted for maternal resuscitation. We explored maternal outcomes associated with MTP utilization.METHODS:
We retrospectively studied women who delivered with Class III-IV hemorrhage (estimated blood loss [EBL] ≥1,500 mL) at either an urban teaching-hospital serving high-risk patients (HOSP1) or a suburban hospital serving average-risk patients (HOSP2) during 2012–2015. Patient groups included: 1) no transfusion, 2) transfusion without MTP, and 3) transfusion via MTP (implemented at HOSP1 only). Between-group differences in maternal characteristics and outcomes by year and hospital were described.RESULTS:
Women totaled 109 at HOSP1 (no transfusion: 30 [28%], transfusion: 56 [51%], MTP: 23 [21%]) and 42 at HOSP2 (no transfusion: 18 [43%], transfusion: 24 [57%]). Transfusion reactions (n=2) occurred in the transfusion group only, and no maternal deaths occurred. No statistically significant patterns were detected in length of stay (LOS) or renal, hematologic, or coagulation indices. However, notable patterns were observed at HOSP1 in mean EBL (no transfusion: 1,720 mL, transfusion: 2,048 mL, MTP: 3,417 mL) and postpartum LOS (no transfusion: 3.0 days, transfusion: 3.2 days, MTP: 4.3 days). Thrombocytopenia improved annually with MTP. Total units transfused were greater with MTP (Total 10.2, PRBC 6.6, FFP 2.6, Platelet 0.9) than transfusion (Total 3.6, PRBC 3.0, FFP 0.4, Platelet 0.1). MTP accounted for the only wasted units (mean 0.52, range 0–4).CONCLUSION:
MTP uses more blood products. However, in class III–IV hemorrhages, MTP use may be beneficial without significant adverse outcome.