Blood Product Use for Hemorrhage during Cesarean Delivery

Objective Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality. Little is known about transfusion practices in patients requiring blood tansfusions following cesarean delivery. The objective of this study is to describe the use of blood products, clotting factors, colloids, and antifibrinolytics in a contemporary cohort of patients with hemorrhage during cesarean and compare blood product use with a historic cohort of patients with a similar diagnosis. Study Design Secondary analysis of a multicenter trial of tranexamic acid versus placebo to prevent PPH during cesarean delivery. Patients with qualitative estimated intraoperative blood loss (EBL) of more than 1 L were included in this analysis. Variables analyzed included transfusion of blood products, ratio of transfused packed red blood cell (PRBC) to fresh frozen plasma (FFP) and platelets, and use of clotting factors, anti-fibrinolytics, and colloids. Transfusion strategies were also compared with a historic cohort from the APEX study. Results Of the 707 (7.7%) who had EBL of greater than 1 liter, packed red cells were transfused in 21.1%, FFP in 5.4%, platelets in 2.4%, and cryoprecipitate in 2.3%. Among patients who received both PRBC and FFP, three quarters had a PRBC:FFP ratio between 1:1 and 2:1. Patients receiving both PRBC and platelets had a 1:1 ratio or less in 76.5% of cases. Clotting factor concentrates were not used in any case. Albumin was administered in 10.2% of cases. When compared with the historic cohort with an EBL > 1 L during cesarean, no differences in the use of blood products was noted. Conclusion 1 in 5 patients with intraoperative EBL > 1 L received PRBC transfusion. The use of other blood products was rare. There was no difference in transfusion strategies overtime when compared with a similar historic cohort. Obstetrical hemorrhage in patients undergoing cesarean delivery rarely involves intensive transfusion therapy. Key Points A total of 21% of patients with hemorrhage during cesarean received packed red cells. Use of other blood products was rare. Pathological activation of the clotting cascade is unlikely. No difference in transfusion strategies was noted overtime.