(1069) Contemporary medical management of obstetrical hemorrhage during cesarean delivery

To describe the use of blood products, intravenous fluids, clotting factors, and antifibrinolytics in a contemporary cohort of patients with obstetrical hemorrhage during cesarean delivery.


Study Design:

Secondary analysis of a multicenter trial of tranexamic acid (TXA) vs placebo to prevent postpartum hemorrhage during cesarean delivery. The primary outcome of this study was transfusion of packed red blood cells (PRBC) by hospital discharge or 7 days after delivery. Patients with estimated intraoperative blood loss (EBL) more than 1 liter were included in this analysis. Variables analyzed included transfusion of blood products, ratio of transfused PRBC to fresh frozen plasma (FFP), use of clotting factors, anti-fibrinolytics, and colloids. Rates are presented with 95% confidence intervals and volumes with medians and interquartile ranges.  Rates of packed red cells and open-label TXA were compared for temporal change across calendar years.


Results:

10,993 patients were included in the original trial, of whom 707 (6.4%) had EBL over 1 liter. Packed red cells were transfused in 21.1%, fresh frozen plasma in 5.4%, platelets in 2.4%, and cryoprecipitate in 2.3% of patients with EBL > 1 liter. Among patients who received both PRBC and FFP, 76.3% had a PRBC:FFP ratio between 1:1 and 2:1. Clotting factor concentrates were not used in any case. Albumin was administered in 10.2 % of cases. Open label TXA was used in 11.6% of participants (Table 1). We found no temporal trends in use of blood products or TXA over the duration of the primary study (Table 2).


Conclusion:

About 1 in 5 patients with EBL > 1 liter received PRBC transfusion, with vast majority receiving less than 3 units. The use of other blood products was rare. While about 1 in 10 received antifibrinolytics, clotting factor concentrates were not used in any case. These results suggest that obstetrical hemorrhage in patients undergoing cesarean delivery rarely requires intensive transfusion therapy. Transfusion practices did not change over the 4 years of the study.