Blood product use for hemorrhage during cesarean delivery

Background: Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality. Little is known about transfusion practices in patients requiring blood tansfusions following cesarean delivery. Objective: To describe the use of blood products, clotting factors, colloids, and antifibrinolytics in a contemporary cohort of patients with hemorrhage during cesarean and compare blood product use with a historic cohort of patients with a similar diagnosis. Study design: Secondary analysis of a multicenter trial of tranexamic acid (TXA) vs placebo to prevent postpartum hemorrhage during cesarean delivery. Patients with qualitative estimated intraoperative blood loss (EBL) of 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) and platelets, and use of clotting factors, anti-fibrinolytics, and colloids. Transfusion strategies were also compared with a historic cohort from the APEX study. Results: Of the 707 (7.7%) who had EBL of greater than 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%. Among patients who received both PRBC and FFP, three quarters had a PRBC:FFP ratio between 1:1 and 2:1. Patients receiving both PRBC and platelets had a 1:1 ratio or less in 76.5% of cases. Clotting factor concentrates were not used in any case. Albumin was administered in 10.2% of cases. When compared with the historic cohort with an EBL >1 liter during cesarean, no differences in the use of blood products was noted. Conclusions: 1 in 5 patients with intraoperative EBL > 1 liter received PRBC transfusion. The use of other blood products was rare. There was no difference in transfusion strategies overtime when compared with a similar historic cohort. Obstetrical hemorrhage in patients undergoing cesarean delivery rarely involves intensive transfusion therapy.