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massive transfusion protocol obstetrics

Courtney Stanley Sundin, Lauren Bradham Mazac
Amniotic fluid embolism (AFE) is a rare but serious and potentially deadly complication of pregnancy that is unpreventable and unpredictable. Most AFE events occur during labor; however, approximately one third happen during the immediate postpartum period. Presentation is abrupt and thought to be an abnormal response to fetal materials entering maternal circulation through the placental insertion site. Care providers must recognize the signs and symptoms of AFE and react quickly in effort to treat potential complications...
October 13, 2016: MCN. the American Journal of Maternal Child Nursing
A Le Gouez, F J Mercier
Major obstetric hemorrhage is a challenge for anesthesiologists because it remains responsible for over 10% of maternal deaths in high-income countries. A standardized multidisciplinary management, described in locally validated protocols and based on international guidelines is mandatory to prevent these deaths. The first difficulty relies on the systematic underestimation of the bleeding. Collection bags must be used to facilitate the diagnosis and therefore rapid management. The etiologies in antenatal or postpartum must be well-known in order to be treated adequately...
August 31, 2016: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
E Guasch, F Gilsanz
Massive obstetric hemorrhage is a major cause of maternal mortality and morbidity worldwide. It is defined (among others) as the loss of>2,500ml of blood, and is associated to a need for admission to critical care and/or hysterectomy. The relative hemodilution and high cardiac output found in normal pregnancy allows substantial bleeding before a drop in hemoglobin and/or hematocrit can be identified. Some comorbidities associated with pregnancy can contribute to the occurrence of catastrophic bleeding with consumption coagulopathy, which makes the situation even worse...
June 2016: Medicina Intensiva
Vedran Stefanovic
PURPOSE OF REVIEW: This article aims not only to review recent literature about the clinical features of massive fetomaternal hemorrhage (FMH) and identification of risk factors, but also to alert obstetricians and pediatricians to this underdiagnosed and underestimated severe obstetrical issue. In addition, a simplified flow chart for the antenatal management of suspected FMH is proposed. RECENT FINDINGS: Improvements in obstetrical and neonatal care have decreased perinatal morbidity and mortality and the rate of stillbirth...
April 2016: Current Opinion in Obstetrics & Gynecology
A Ioscovich, D Shatalin, A J Butwick, Y Ginosar, S Orbach-Zinger, C F Weiniger
BACKGROUND: Anesthesia practices for placenta previa (PP) and accreta (PA) impact hemorrhage management and other supportive strategies. We conducted a survey to assess reported management of PP and PA in all Israeli labor and delivery units. METHODS: After Institutional Review Board waiver, we surveyed all 26 Israeli hospitals with a labor and delivery unit by directly contacting the representatives of obstetric anesthesiology services in every department (unit director or department chair)...
April 2016: Acta Anaesthesiologica Scandinavica
Luis D Pacheco, George R Saade, Maged M Costantine, Steven L Clark, Gary D V Hankins
Obstetrical hemorrhage remains a leading cause of maternal mortality worldwide. New concepts involving the pathophysiology of hemorrhage have been described and include early activation of both the protein C and fibrinolytic pathways. New strategies in hemorrhage treatment include the use of hemostatic resuscitation, although the optimal ratio to administer the various blood products is still unknown. Massive transfusion protocols involve the early utilization of blood products and limit the traditional approach of early massive crystalloid-based resuscitation...
March 2016: American Journal of Obstetrics and Gynecology
Eileen Lew, Shephali Tagore
INTRODUCTION: Intraoperative cell salvage (ICS) is an important aspect of patient blood management programmes. An ICS service was introduced at KK Women's and Children's Hospital, Singapore, from 2 May 2011 to 30 April 2013 to aid in the management of massive obstetric haemorrhage. METHODS: With support from the Ministry of Health's Healthcare Quality Improvement and Innovation Fund, a workgroup comprising obstetricians, anaesthetists and nursing staff was formed to develop training requirements, clinical guidelines and protocols for implementing ICS using the Haemonetics Cell Saver 5...
August 2015: Singapore Medical Journal
J Chay, M Koh, H H Tan, J Ng, H J Ng, N Chia, P Kuperan, J Tan, E Lew, L K Tan, P L Koh, K A Desouza, S Bin Mohd Fathil, P M Kyaw, A L Ang
BACKGROUND: A common national MTP was jointly implemented in 2011 by the national blood service (Blood Services Group) and seven participating acute hospitals to provide rapid access to transfusion support for massively haemorrhaging patients treated in all acute care hospitals. METHODS: Through a systematic clinical workflow, blood components are transfused in a ratio of 1:1:1 (pRBC: whole blood-derived platelets: FFP), together with cryoprecipitate for fibrinogen replacement...
January 2016: Vox Sanguinis
Alexander J Butwick, Lawrence T Goodnough
PURPOSE OF REVIEW: Major obstetric hemorrhage is a leading cause of maternal morbidity and mortality. We will review transfusion strategies and the value of monitoring the maternal coagulation profile during severe obstetric hemorrhage. RECENT FINDINGS: Epidemiologic studies indicate that rates of severe postpartum hemorrhage (PPH) in well resourced countries are increasing. Despite these increases, rates of transfusion in obstetrics are low (0.9-2.3%), and investigators have questioned whether a predelivery 'type and screen' is cost-effective for all obstetric patients...
June 2015: Current Opinion in Anaesthesiology
Rachel M Kacmar, Jill M Mhyre, Barbara M Scavone, Andrea J Fuller, Paloma Toledo
BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of severe maternal morbidity, cardiac arrest, and death during the hospitalization for childbirth. Protocol-driven care has been associated with improved outcomes in many settings; the National Partnership for Maternal Safety now recommends that PPH protocols be implemented in every labor and delivery unit in the United States. In this study, we sought to identify the level of PPH protocol availability in academic United States obstetric units...
October 2014: Anesthesia and Analgesia
Cathi Phillips, Jean Bulmer
Abdominal pain is commonly reported by women seeking care in obstetric triage, and although it it is often benign, careful assessment is warranted. A rare cause of left upper quadrant pain during pregnancy is splenic artery aneurysm rupture, which can result in massive hemorrhage and maternal and fetal mortality. In women who survive, serious complications from bleeding and multiple transfusions require intensive care. There have been reports in the literature of improved outcomes with utilization of hemostatic resuscitation protocols...
December 2013: Nursing for Women's Health
H P Pham, B H Shaz
Massive haemorrhage requires massive transfusion (MT) to maintain adequate circulation and haemostasis. For optimal management of massively bleeding patients, regardless of aetiology (trauma, obstetrical, surgical), effective preparation and communication between transfusion and other laboratory services and clinical teams are essential. A well-defined MT protocol is a valuable tool to delineate how blood products are ordered, prepared, and delivered; determine laboratory algorithms to use as transfusion guidelines; and outline duties and facilitate communication between involved personnel...
December 2013: British Journal of Anaesthesia
N Burgos Frías, E Gredilla, E Guasch, F Gilsanz
Massive obstetric hemorrhage still remains a major cause of maternal mortality and morbidity. The risk factors associated with this pathology must be identified in order to schedule the appropriate delivery with the necessary resources. A case is presented of an iliac artery occlusion with intravascular balloons for suspected placenta accreta during cesarean section. The perioperative treatment, as well as an analysis of the treatment options is described, along with their advantages and disadvantages, from the use of postpartum hemorrhage protocols, blood transfusion and procoagulant factors, and other maneuvers to control bleeding, until the hysterectomy...
February 2014: Revista Española de Anestesiología y Reanimación
Chitra Sivasankar
Placenta percreta is a rare pregnancy disorder in which the placenta penetrates the uterine myometrium and can invade surrounding organs. Because the rate of cesarean sections is increasing in developed countries, the incidence of placenta percreta is also rising. This condition significantly increases the risk of maternal and fetal morbidity and mortality, and is currently the most common indication for peripartum hysterectomy. Multidisciplinary management in a specialized center capable of providing massive transfusions can improve outcomes for the mother and baby...
2012: International Journal of Women's Health
Luis D Pacheco, George R Saade, Maged M Costantine, Steven L Clark, Gary D V Hankins
Obstetric hemorrhage is a leading cause of maternal mortality worldwide. New concepts involving the pathophysiology of hemorrhage have been described and include early activation of both the protein C and fibrinolytic pathways. New tendencies in hemorrhage treatment include the use of hemostatic resuscitation. Massive transfusion protocols involve the early utilization of blood products and limit the traditional approach of early massive crystalloid based resuscitation. The evidence behind hemostatic resuscitation is still limited...
January 2013: American Journal of Perinatology
M C Gutierrez, L T Goodnough, M Druzin, A J Butwick
BACKGROUND: A massive transfusion protocol may offer major advantages for management of postpartum hemorrhage. The etiology of postpartum hemorrhage, transfusion outcomes and laboratory indices in obstetric cases requiring the massive transfusion protocol were retrospectively evaluated in a tertiary obstetric center. METHODS: We reviewed medical records of obstetric patients requiring the massive transfusion protocol over a 31-month period. Demographic, obstetric, transfusion, laboratory data and adverse maternal outcomes were abstracted...
July 2012: International Journal of Obstetric Anesthesia
Bryan C Morse, Christopher J Dente, Erica I Hodgman, Beth H Shaz, Anne Winkler, Jeffrey M Nicholas, Amy D Wyrzykowski, Grace S Rozycki, David V Feliciano
There are little data regarding the use of massive transfusion protocols (MTP) outside of the trauma setting. This study compares the use of an MTP between trauma and non-trauma (NT) patients. Data were collected for trauma and NT patients from the prospectively maintained MTP database at a Level I trauma center over a 4-year period. Massive transfusion was defined as ≥ 10 units packed red blood cells (PRBCs) in a 24-hour period. Of 439 MTP activations, 37 (8%) were NT patients (64% male; mean age = 51 years, initial base deficit = -10...
June 2012: American Surgeon
Marie-Pierre Bonnet, Olga Basso
Obstetric hemorrhage is a major cause of maternal morbidity and mortality. Pregnancy is associated with substantial hemostatic changes, resulting in a relatively hypercoagulable state. Acquired coagulopathy can, however, develop rapidly in severe obstetric hemorrhage. Therefore, prohemostatic treatments based on high fresh frozen plasma and red blood cell (FFP:RBC) ratio transfusion and procoagulant agents (fibrinogen concentrates, recombinant activated factor VII, and tranexamic acid) are crucial aspects of management...
April 2012: Seminars in Thrombosis and Hemostasis
Luis D Pacheco, George R Saade, Alfredo F Gei, Gary D V Hankins
Hemorrhagic shock is the most common form of shock encountered in obstetric practice. Interventions that may limit transfusion requirements include normovolemic hemodilution, use of recombinant activated factor VII, selective embolization of pelvic vessels by interventional radiology, and the use of the cell saver intraoperatively. Current understanding of the mechanisms of acute coagulopathy calls into question the current transfusion guidelines, leading to a tendency to apply massive transfusion protocols based on hemostatic resuscitation despite lack of prospective data...
December 2011: American Journal of Obstetrics and Gynecology
Michael Kalina, Glen Tinkoff, Gerard Fulda
OBJECTIVE: Postpartum hemorrhage is a leading cause of maternal mortality. Massive transfusion in obstetric patients is rare. Recombinant Factor VIIa (rFVIIa) use in trauma patients with massive transfusion is efficacious. Our goal was to evaluate the safety and efficacy of rFVIIa use in obstetric patients with massive postpartum hemorrhage (MPH). METHODS: Patients records with MPH from 2003 to 2006 were reviewed. Data collected were demographics, APACHE II scores, International Normalized Ratio (INR), fibrinogen level, blood product administration, rates of pulmonary embolism (PE), deep vein thrombosis (DVT), myocardial infarction (MI), hysterectomy, and mortality...
April 2011: Delaware Medical Journal
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