Abstract:
Objective To investigate the effect of transfusion protocol on maternal outcomes in patients with placenta accreta spectrum (PAS) and severe postpartum hemorrhage (sPPH).
Methods Make a retrospective analysis of the clinical data of 262 puerpera who were diagnosed with PAS, underwent cesarean delivery, developed sPPH, and received a blood transfusion from January 1, 2018 to October 31, 2021, in the Third Affiliated Hospital of Guangzhou Medical University. The patients were divided into groups according to the total amount of bleeding in 24 hours after the operation and the infusion ratio of red blood cell (RBC) to fresh frozen plasma (FFB): 151 cases of moderate sPPH (the total amount of bleeding 24 hours >1000~2000 ml) were divided into four groups: 1A (RBC∶FFB<1∶1, 17 cases), 1B (RBC∶FFB=1∶1, 45 cases), 1C(RBC∶FFB>1∶1, 17 cases) and 1D (RBC only, 72 cases); Severe SPPH (the total amount of bleeding 24 hours >2000 ml, 111 cases) were divided into three groups: 2A(RBC∶FFB<1∶1, 19 cases), 2B(RBC∶FFB=1∶1, 43 cases) and 2C (RBC∶FFB>1∶1, 49 cases). The general clinical data, intraoperative conditions, blood consumption in 24 hours and postoperative complications of puerpera in each group under different bleeding conditions were analyzed.
Results (1) The total blood loss at 24 h after operation of the four groups 1A-1D were 1510.91±285.72, 1440.22±244.87, 1563.41±167.13, and 1340.93±293.16, respectively, the 1C was the most and the 1D was the least, and there was a statistical difference between the 1C and 1D (P<0.05). The infusion of RBC (U) were 2.91±1.27, 3.28±1.21, 4.88±0.99, and 2.61±1.12, respectively. The 1C was the most and the 1D was the least, and there was statistical difference between 1C and 1A, 1B, and 1D respectively (P<0.05); the infusion of FFB (ml) were 452.94±141.94, 327.78±121.34, 308.02±93.93, 0, respectively, 1A was the most which had statistical differences with 1B and 1C (P<0.05). According to the transfusion of blood products in the 24 hours after the operation(RBC and FFB), 1D used the least blood in the four groups. The total blood loss at 24 h after operation of the three groups 2A-2C were not statistically significant (P>0.05); infusion of RBC (U) were 5.76±2.48, 5.30±1.63, 8.20±4.16, 2C was the most, and there were statistical differences with 2A and 2B (P<0.05); FFB infusion (ml) were 760.53±292.77, 530.23±162.62, and 548.98±326.04, respectively, 2A was the most which had statistically significant differences with 2B and 2C (P<0.05). According to the transfusion of blood products in the 24 hours after the operation(RBC and FFB), 2B used the least blood in the three groups. (2) There was no significant difference in the length of hospital stay, transfer rate to ICU, and postoperation complications (except the ratio of PLT decrease) among the four groups 1A-1D and the three groups 2A-2C (P>0.05). All puerpera survived with no deaths.
Conclusions For patients with placenta accreta spectrum undergoing cesarean section, the blood transfusion strategy of a single infusion of RBC can be considered in moderate sPPH patients while RBC∶FFB=1∶1 can be considered firstly in serve sPPH patients, and then perform individualized blood transfusion according to subsequent bleeding and blood test indicators.
Key words:
Placenta accreta,
Postpartum hemorrhage,
Blood transfusion
Yong Wang, Xialin Li, Rong Yang, Kangni Pan, Lin Yu, Weiwei Wang, Wen Sun, Dunjin Chen. A study of transfusion protocol in placenta accreta complicated with severe postpartum hemorrhage[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2023, 12(03): 173-179.