Prognosis units of red cells13. Further FFP transfusion would




















Prognosis and successful maternal and neonatal
outcomes of patients admitted to an intensive care unit depend not only on the
patient factors but also on a multidisciplinary team work from obstetricians,
anaesthetists, intensivists, haematologists, transfusion physicians, neonatologists,
and other specialists.4,21


The target is
to keep the fibrinogen level above 1.5 g/l.13 The amount of blood
components transfused may vary depending on the local massive transfusion
protocols, although a commonly
followed massive transfusion protocol is RBC: FFP: platelets as 4:4:1 ratio.4,20

We Will Write a Custom Essay Specifically
For You For Only $13.90/page!

order now

In major
obstetric haemorrhage, FFP at a dose of 12–15 ml/kg should be given for every 6
units of red cells13. Further FFP transfusion would be decided by the
coagulation investigations. The target of transfusions is to maintain the
prothrombin time (PT) and activated partial thromboplastin time (APTT) ratios
at less than 1.5 times normal. Cryoprecipitate is given early in severe
bleeding episodes as two 5-unit pools.

Fresh frozen plasma and cryoprecipitate


In an acutely bleeding
patient platelet count should be maintained above 50 x 109 /l and the trigger of trigger of 75 x 109
/l is recommended by the RCOG guidelines for blood transfusion in obstetrics.

A platelet count of
50 × 109/l is usually taken as adequate
for procedures. For epideural anesthesia, a patient requires a platelet count
of 80 × 109/l and in such cases
prophylactic platelet transfusions are given. 13,23



As per the
RCOG guidelines for blood transfusion in obstetrics, red cells transfusion is
almost always required when the Hb is less than 60 g/l and it is rarely
required when the Hb is greater than 100 g/l. 13

The decision
to initiate transfusion on a patient depends on various factors. There are no given
solid criteria for starting red cell transfusion. This should be individualised
depending on the clinical profile of each patient.13,19,20

Red cells


Transfusion triggers







Massive haemorrhage is a well described indication13
for FFP and cryoprecipitate transfusion, while other pregnancy associated
conditions such as thrombotic thrombocytopenic purpura and acute fatty liver of
pregnancy complicated with bleeding conditions as well require FFP transfusion.


Fresh frozen plasma and cryoprecipitate


Conservative management will be sufficient for most of
the cases while platelet
transfusion may be needed during the first two trimesters only if the patient
is symptomatic, with a low platelet count or when an invasive procedure is

Thrombocytopenia is one of the common findings during
pregnancy. Several causes have been identified for the mild reduction in
platelets including gestational thrombocytopenia, Immune thrombocytopenia where
the patient usually will not require a platelet transfusion. There are certain
causes which are specific to pregnancy such as HELLP syndrome, acute fatty
liver of pregnancy and other causes which are associated with pregnancy as
thrombotic thrombocytopenic purpura, haemolytic uremic syndrome and disseminated
intravascular coagulation. 22,23

Platelet transfusion



The common
conditions that lead to antepartum haemorrhage are placental abruption,
placenta previa, vasa praevia, ectopic pregnancy and uterine rupture.
Post-partum haemorrhage is responsible for the majority of morbidity and
mortality in obstetric haemorrhage9,10,11. World Health Organization statistics suggest that 60% of
maternal deaths in developing countries are due to PPH.9,10,11 PPH could be primary, if
occurs in the first 24 hours of delivery or secondary if it occurs after 24
hours after and within 6 weeks of delivery. The causes for PPH are uterine
atony, retained placenta or placenta accreta, genital tract trauma and

Obstetric haemorrhage is the leading cause of maternal
mortality1,4,8, about 13% in developed countries to 34% in Africa.12 More than 80% of obstetric haemorrhage cases
are recorded postpartum9, which is responsible for 25% of the
estimated 358,000 maternal deaths each year1,8,10,11,17. Significant
obstetric haemorrhage is defined as blood loss greater than 1000 mL and major
haemorrhage if greater than 2500 mL and/ or the transfusion of five or more
units of blood and/or requiring treatment for coagulopathy. This could be antepartum
or postpartum haemorrhage.

Early detection of anaemia and
investigations to find the cause and correction will avoid the need for
transfusion14,15. As for any other patients, the decision for
transfusion should not be made only by considering the haemoglobin13,15,
since clinically stable women do not require blood transfusion even with Hb of