What is the proportion of maternal death, the obstetric haemorrhage is responsible for?
10 % of direct deaths
The 3rd leading cause of direct maternal death in UK
Can the risk of blood transfusion be reduced?
By optimization of HB in the antenatal period
What is the definition of anaemia in pregnancy?
first trimester haemoglobin (Hb) less than 110 g/l,
second/third
trimester Hb less than 105 g/l,
postpartum Hb less than 100 g/l,
If normocytic or microcytic anaemia has been detected in pregnancy, what is the first step?
a trial of oral iron should be considered as the first step and
further tests should be undertaken if there is no demonstrable rise in Hb at 2 weeks
When should a Pregnant woman be offered screening for anaemia ?
At booking
At 28 w
In twin pregnancies: at booking/ at 20-24 w / at 28 w
When is Parenteral iron indicated for the management of antenatal anaemia?
1-oral iron is not tolerated or absorbed
2-patient compliance is in
doubt
3- if the woman is approaching term and there is insufficient time for oral supplementation
What is the role of recombinant human erythropoietin (rHuEPO) for non-end-stage renal anaemia in pregnant women?
should only be used in the context of a controlled clinical trial
🔮 it’s used mostly in the anaemia of end stage renal disease
When should pregnant women test their blood group & screen antibodies status?
All women should have their blood group and antibody status checked
at booking and at 28 w
What is the time limit for using blood group & screen samples for provision of blood in pregnancy?
should be less than 3 days old.
When to check blood group & screen In a woman at high risk of emergency transfusion, e.g. placenta praevia ?
should be sent once a week to exclude or
identify any new antibody formation and to keep blood available if necessary
If there is an automated testing for blood grouping and
antibody testing , what is the need for cross matching ?
no cross-matching needed,
no need to reserve units for individual cases
If secure electronic patient identification systems are not available, how to manage a first-time patient prior to transfusion ?
a second sample should be
requested for confirmation of the ABO group
What is Blood product specification in pregnancy ?
1-ABO-, RhD- and K- (Kell-) compatible red cell units
2-unless a woman is known to be K positive, only K-negative blood should be used for transfusion in women of childbearing age
3-(CMV-) seronegative red cell and platelet components should be provided for elective transfusions
4- in emergency: standard
leucocyte-depleted components should be given to avoid delay and CMV-negative blood or
platelets are not needed for transfusion
Is there a role for preoperative/predelivery autologous blood deposit?
Predelivery autologous blood deposit is not recommended.
Is there a role for intraoperative cell salvage (IOCS)?
1-where the anticipated blood loss is great enough to
induce anaemia
2-or expected to exceed 20% of estimated blood volume.
🔱 should only be performed by multidisciplinary teams
How to manage in case of IOCS during CS in RhD-negative, previously nonsensitised women & cord blood group is confirmed as RhD positive (or unknown) ?
minimum dose of 1500 iu
anti-D immunoglobulin should be administered following the reinfusion of salvaged red cells.
maternal blood sample should be taken for estimation of fetomaternal haemorrhage 30–40
minutes after reinfusion in case more anti-D is indicated.
Why is anti D immunisation required after IOCS in RhD-negative women?
iOCS is effective at removing the common markers of amniotic fluid contamination.
it will not remove fetal blood cells
In what circumstances should fresh frozen plasma (FFP) be used?
FFP at a dose of 12–15 ml/kg should be administered for every 6 units of red cells
Subsequent FFP transfusion should be guided by the results of clotting tests
Aiming for PT / PTT < 1,5
In what circumstances should Cryoprecipitate be used ?
standard dose of two 5-unit pools should be administered early in major
obstetric haemorrhage. Subsequent cryoprecipitate transfusion should be guided by fibrinogen
results, aiming to keep levels above 1.5 g/l.
Is anti D immunization necessary if a RhD-negative woman receives RhD-positive FFP or
cryoprecipitate ?
should ideally be of the same group as the recipient
BUT ; No anti-D prophylaxis is required
What is the threshold of fibrinogen associated with increased risk of PPH ?
< 2,9
🌸 normal ranges in pregnancy (varying between 3.5 and 6.5 g/l)
When should platelets be used?
A platelet transfusion trigger of 75 x 109/l is recommended to provide a margin of safety
🔱 Aim to maintain the platelet count above 50 x 109/l
If RhD-positive platelets are transfused to a RhD-negative woman of childbearing potential , how to manage?
A dose of 250 iu anti-D immunoglobulin is sufficient
❤️ This may be given subcutaneously to minimise bruising in thrombocytopenic women
for management of major obstetric haemorrhage, Is there a role for recombinant factor VIIa (rFVIIa) therapy?
The use of rFVIIa may be considered as a treatment for life-threatening PPH
