Haematological features, transfusion management and outcomes of massive obstetric haemorrhage: findings from the Australian and New Zealand Massive Transfusion Registry

摘要

Massive obstetric haemorrhage (MOH) is a leading cause of maternal morbidity and mortality world-wide. Using the Australian and New Zealand Massive Transfusion Registry, we performed a bi-national cohort study of MOH defined as bleeding at >= 20 weeks' gestation or postpartum requiring >= 5 red blood cells (RBC) units within 4 h. Between 2008 and 2015, we identified 249 cases of MOH cases from 19 sites. Predominant causes of MOH were uterine atony (22%), placenta praevia (20%) and obstetric trauma (19%). Intensive care unit admission and/or hysterectomy occurred in 44% and 29% of cases, respectively. There were three deaths. Hypofibrinogenaemia ( = 6 RBC units before the first cryoprecipitate (odds ratio [OR] 3 center dot 5, 95% CI: 1 center dot 7-7 center dot 2), placenta praevia (OR 7 center dot 2, 95% CI: 2 center dot 0-26 center dot 4) and emergency caesarean section (OR 4 center dot 9, 95% CI: 2 center dot 0-11 center dot 7) were independently associated with increased risk of hysterectomy. These findings confirm MOH as a major cause of maternal morbidity and mortality and indicate areas for practice improvement.