Quantification of blood loss in obstetric haemorrhage: intervention & transfusion TOFG 2023

Question 1

What is the comments cause of significant bleeding in pregnancy?

Answer 1

PPH
2% women world wide

Question 2

Leading cause of maternal mortality worldwide?

Answer 2

Haemorrhage
27% of all maternal death

Question 3

Most common cause admission to ITU in obstetric patients

Answer 3

PPH

Question 4

As per RCOG categorisation of blood loss
- Minor
- Major - moderate
- Major - severe

Answer 4

• Minor >500-1000
• Major - moderate 1000-2000
• Major - severe >2000

Question 5

Table explaining estimated blood volumes per weight

Answer 5

Each 10kg, 1000ml more TBV

Question 6

What proportion on UK deliveries have blood loss >500mls?

Answer 6

25%

> 1000ml 10%
2000mls <1%

Question 7

Most common cause of death from blood transfusion?

Answer 7

TACO

Question 8

Risk of alloimmunisation in transfused patients

Answer 8

1-6%

Question 9

% of blood flow to uterus ar term?

Answer 9

15%
700ml/min

Question 10

What are the 2 quantitive measurement of blood loss

Answer 10

Gravimetric - weigh swabs and substract dry weight

Volumetric - mesure blood loss from under buttock drape

Question 11

Table explaining feature methods of measurement of blood loss

Answer 11

Question 12

Which form of measure is used as gold standard when comparing other methods?

Answer 12

Photometric analysis using alkaline haematin method

+/- 10% blood loss
20 hours to complete

Question 13

How is shock index calculated?
Normal outside pregnancy
High in pregnancy

Answer 13

HR/SBP

Non obstetric normal 0.5-0.7

Obstetric >0.9 - increased risk BT, ITU, intervention

Question 14

What significant changes to haemostats is seen after delivery of the placenta?

Answer 14

Increase in fibrinolysis, exacerbate PPH

Question 15

How long can it take for Hb to drop in haemorrhage

Answer 15

6 hours
Hb measurements in active haemorrhage not accurate

Question 16

What part of the coagulation path way to thromboelastography (TEG) and rotation thromboelastometry (ROTEM) measure?

Answer 16

Extrinsic pathway
If prolonged - required FFP

Question 17

What does the FibTEM value in ROTEM and FF in TEG inform you?

Answer 17

Fibrin contribution to clot

Fibtem>FF in assessing low fibrinogen

Question 18

What happens to lactate in PPH

Answer 18

Rises - >4 associated with increased martialist/transusion

Question 19

Inpact ob OBS cmyru QUIP in wale
- Changed to number of women transfused RBC
- FFP

Answer 19

RBC - reduced 22%
FFP - reduced 43%

Question 20

OBS Cymru algorithm

Answer 20