Massive Transfusion Protocol: A Boon for Salvaging Patients of Obstetric Hemorrhage

Background: Maternal mortality remains a major global health issue, with obstetric hemorrhage as the primary cause. Timely and effective blood transfusion is crucial for maintaining organ perfusion and oxygenation. This study seeks to evaluate maternal outcomes, focusing on survival rates and life-threatening complications following massive blood transfusion.

Materials and Methods: A prospective observational study was conducted between July 2022 to January 2024 in the Department of Obstetrics and Gynecology of Shree Krishna Hospital, Karamsad, Gujarat, India which is a rural tertiary care institute catering to Anand and Kheda districts of Central Gujarat. Data included in the study were age, socioeconomic status, parity, weeks of gestation, underlying comorbidities, cause of hemorrhage, mode of management, number and ratio of blood products transfused, and complications of Massive Transfusion (MT).

Results: The MT utilization rate of our institute was 2.74%. The mean age of the study group was 27.3yrs with 84% belonging to the rural population. Out of all 58% were antenatal cases majority being multipara- 61.7%. Post-Partum Hemorrhage (PPH) was the most common cause of massive obstetric hemorrhage i.e. 42%. At the same time, the average time for issuing the first blood product was 12 min. Most cases could be managed conservatively -31 out of 81 using oxytocics and timely blood transfusion. Amongst the operative interventions, obstetric hysterectomy was done in 23.4 % of cases. The overall ratio of Packed Cell Volume (PCV): Fresh Frozen Plasma (FFP): Platelet Concentrate (PC): Cryoprecipitate (CP) in the study was 1:1.02:0.8:2. In 46% of the cases, patients did not suffer from any MT-related complications; Transfusion Associated Circulatory Overload (TACO) was seen in 16% and Transfusion Related Acute Lung Injury (TRALI) in 7.4%. The mortality rate was 5%. Blood transfusion-related complications are observed more with PC, followed by FFP and RCC.

Conclusions: PPH was the leading cause of obstetric hemorrhage. Maternal morbidity and mortality can be significantly reduced through early referral to a tertiary care center, prompt administration of oxytocics, and the timely initiation of massive transfusion and surgical interventions for uncontrolled bleeding. Maintaining a blood product ratio of approximately 1:1.02:0.8 for packed red blood cells (PRBCs), fresh frozen plasma (FFP), and platelets helps prevent coagulopathy, ensures adequate tissue perfusion, and shields the patient from the detrimental cycle of sepsis, hypothermia, hemodilution, and shock. PRC transfusion was maximally responsible for TRALI.