Blood component therapy in postpartum hemorrhage

BACKGROUND: The purpose of this study was to examine blood component therapy in the treatment of postpartum hemorrhage. STUDY DESIGN AND METHODS: Records were reviewed for subjects who delivered during the 5-year period between January 1, 2000, and December 31, 2004, at Duke University Medical Center and had postpartum hemorrhage coded as International Classification of Diseases Version 9 (ICD-9) codes 666.0X, 666.1X, and 666.2X. Records were reviewed to determine whether blood components had been transfused. Data were analyzed using descriptive statistics and the chi-square test. RESULTS: During the 5-year period from January 1, 2000, to December 31, 2004, there were 12,476 deliveries at Duke University Medical Center. A total of 671 or 5.4% had a diagnosis of postpartum hemorrhage. A total of 108 (0.87%) required blood component therapy, 106 received red blood cells (RBCs), and 30 (0.24%) received components other than RBCs. Of these 30, all received fresh-frozen plasma (1-20 units); eight received one to two transfusions of cryoprecipitate (each containing 10 units); and five received between one and three transfusions of apheresis or pooled whole blood platelets. None of the women received hemostatic agents such as antifibrinolytic medication, DDAVP, recombinant Factor VIIa, or clotting factor concentrates. None of the women experienced thromboembolic events postpartum. There were no deaths and none of the women developed organ dysfunction as a result of hemorrhage. CONCLUSION: Among 12,476 deliveries at a major United States medical center with a modern blood bank and readily available blood component therapy, there were no deaths or organ dysfunction as a consequence of severe postpartum hemorrhage.