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���������� � � � � ����!!!8K!g"!QB0s#�#�#�#�#d$d$d$�A�A�A�A�A�A�A$�C�#FL�A]� d$d$d$d$d$�A� � �#�#�B�-�-�-d$�� �#� �#�A�-d$�A�-�-��9h�:�#�����h]h�!:+��9tA!B0QB:|oF�,�oF �:�:
oF� �<�d$d$�-d$d$d$d$d$�A�AR-�d$d$d$QBd$d$d$d$��������������������������������������������������������������������oFd$d$d$d$d$d$d$d$d$�	�:	Title: Maternal and perinatal outcome of life threatening obstetrical complications requiring multiple transfusions.
Abstract
Objective: To evaluate maternal and perinatal outcome of life threatening obstetric complications requiring multiple transfusions.
Materials and Methods: It is an observational study conducted on 112 antenatal and postnatal women admitted in a tertiary level hospital, requiring blood and blood products transfusion of (1.5 liters in 24 hours, over a period of 15 months (Aug 2011 to Oct 2012). The demographic and obstetrical profile, amount transfused, mode of delivery, duration of hospital stay, maternal and neonatal morbidity and mortality was evaluated.
Data analysis: Statistical analysis of the data was performed using chi-squared test.
Results: There were 95 women who presented in antepartum period and 17 in the post-partum. Multigravidas comprised of 70 women, 81 had unsupervised pregnancies and 33 women presented in shock. At admission, 76 peripartum women had severe anemia and 62 had coagulopathy.  Obstetrical hysterectomy was done for 33 women and total 17 women expired. Hemorrhage was the most common indication for transfusion. The mean blood transfusion and volume replacement in 24 hours was 4.2 units & 2.25 liters respectively. The mean hospital stay was 10.15 days. Intra-uterine death at the time of admission was present in 40 women and 72 had live births. After birth, 21 babies required neonatal intensive care, of which 6 expired.
Conclusion: Antenatal care is important to prevent complications though pregnancy is always unpredictable. Patients� condition at admission is single most important factor often influencing the maternal and perinatal outcome.
Key-words: Blood transfusion, maternal and perinatal outcome.
Introduction
Severe obstetric hemorrhage is the major cause of maternal mortality worldwide.[1] The maternal mortality rate is 200-600/100,000 live-births world-wide (27/100,000 in developed countries to 890/100,000 in under-developed), but it is reported to be 212/100,000 for India in 2009.[2] Peripartum hemorrhage is the most important cause of maternal mortality and most of the patients require multiple transfusions in the form of blood and its components. While dealing with such patients, the obstetrical care providers have to make immediate decisions on transfusion management even before the laboratory reports are made available. 
The various studies have been conducted, which have included the criteria of an ICU admission, hysterectomy, and blood loss more than 2500ml or acute transfusion of e" 4 unit of blood which indicates that there were no uniform criteria of inclusion in these studies. Al-Zirqi et al considered visually estimated blood loss of >1500 ml intrapartum and within 24 hours postpartum, or the need for blood transfusion postpartum regardless of the amount of blood loss.[3-7] The visual blood loss may underestimate the actual blood loss that occurred in the patient.[8]
The criterion of blood transfusion of 1500 ml over 24 hours during intra-partum and postpartum was taken in our study as transfusion of >1500 ml indicates >25% of blood volume replacement, which would have been given to correct the hemodynamic decompensation. Management of such cases poses great challenges to the obstetrical care-providers. 
The aim of this study was to evaluate maternal and fetal outcome of life threatening obstetrical complications requiring multiple transfusions.
Methods
An observational study enrolling 112 patients was conducted in a tertiary care center of Delhi from August 2011 to October 2012. It is a tertiary care hospital and an obstetric center with more than 15,000 deliveries a year. The data was obtained from medical record sheet of the patients. The peri-partum women who required more than 1.5 liters of blood or blood products in 24 hours after admission were recruited in the study. Some of these women presented with hypotension i.e. decrease in blood pressure by 20%, tachycardia of more than 110 beats per minute and in shock or with the clinical or the biochemical evidence of coagulopathy. The patients with severe chronic anemia, not presenting in labor or with isolated thrombocytopenia at the time of admission were excluded from the study population. In this study, the blood product volume transfused was taken as the criteria and not the units, as some patients would have required only multiple units of fresh frozen plasma (FFP) and not red cell concentrate (RCC) or platelets. One unit of whole blood was taken as 350 ml, one unit of RCC as 250 ml, one unit of FFP as 150 ml and platelet concentrate as 75 ml. The decision for transfusion was based upon the clinical assessment as well as laboratory investigations. The patients� demographical profile, antenatal care provided and associated medical or obstetrical complications which may have had developed at or after admission and acute cause called for transfusion were evaluated. The investigations done for the patient, blood products required for management, mode of termination of pregnancy as well as the maternal and perinatal outcome were taken into account.
Data analysis
Statistical analysis of the data was performed using chi-squared test. A p-value of <0.05 was considered as statistically significant.
Results
During these 15 months, there were 112 patients who required e"1.5 liters of transfusion and fulfilled the inclusion criteria, constituted the study population. The demographic and the obstetrical data of the patients are shown in table 1. The mean age of the women included was 26.4 years.  In this study, there were 84.8% (n=95) women who presented in antepartum period and 15.2% (n=17) in the post-partum. Most of the antepartum women who received multiple transfusions were multigravidas (73.7%, n=70) with period of gestation more than 35 weeks (65.3%, n=62). Being a tertiary care and a referral center, we encounter more of unbooked cases (72.3%, n=81) with obstetrical complications like antepartum hemorrhage (APH), pregnancy induced hypertension (PIH), rupture uterus, previous lower segment caesarean section (LSCS), obstructed labor, atonic or traumatic post-partum hemorrhage (PPH), delivery by untrained personnel etc which require emergency care and transfusion therapy. At admission, 33 women (29.5%) presented to the emergency in a state of shock, 67.8% (n=76) peripartum women had severe anemia (hemoglobin < 7 gm/dl), 55.3% (n=62) had coagulopathy and 54 presented with thrombocytopenia (platelet count below one lac.)
The mode of delivery is shown in table 1.  Amongst the 95 antepartum women, 34(35.7%) had vaginal deliveries, 36(37.8%) had caesarean section and 25 (26.3%) underwent obstetrical hysterectomy. Obstetrical hysterectomy was done for six patients after vaginal delivery, 14 after caesarean section and five women had emergency laparotomy with hysterectomy for rupture uterus at the time of presentation. Emergency laparotomy with repair of the uterus was done for three patients. In the post-partum population, eight had undergone obstetrical hysterectomy for postpartum hemorrhage. 
All the patients received blood which was screened, cross-matched and released from the hospital blood-bank. As depicted in table 2, the most common indication for transfusion was post-partum hemorrhage (25%) followed by ante-partum hemorrhage (18.8%). Blood transfusion was given in the form of whole blood (WB) and red cell concentrate (RCC), fresh frozen plasma (FFP) and platelet concentrate. The mean blood transfusion given to these patients in 24 hours was 4.2 units and mean volume replacement in 24 hrs was 2.25 litres.
The co-morbidities in the women receiving multiple transfusions are given in table 3. Obstetrical hysterectomy was done for 29.5% (n=33) women in our study group. Maternal mortality was higher in women who underwent obstetrical hysterectomy although it was not statistically significant (p=0.08). Women experienced overlapping co-morbidities varying from wound infection; lower respiratory tract infection, septicaemia, pressure sores due to prolonged immobility to acute renal failure. 
The maximum duration of hospital stay of the mother was 65 days, the mean stay being 10.15 days.  Close monitoring in intensive care units(ICU) was done for 44 patients with a mean stay of 2.6 days and there were 15.2% (n=17) maternal deaths. Most of the women who expired (11.6%) or presented in shock (18.8%) had severe anaemia (hemoglobin of 4 to 7 gm/dl). None of the patients had multiple gestations. Intra-uterine death at the time of admission was present in 40 patients and 72 had live births. Out of the 72 live-born, 21 babies required transfer to neonatal intensive care units (NICU) soon after delivery, of which six expired. The parity of the women was not significantly associated with maternal mortality (p=0.54) or perinatal outcome (p=0.15). Though this study had greater number of unbooked cases, but it was not significantly associated with increased perinatal (p=0.38) or maternal (p=0.77) mortality.
Discussion
In this study, the rate of multiple transfusions in 15 months in our institute was 0.62%, which is in accordance with the incidences reported previously, 0.3�1%.[9-11] The prevalence of severe obstetrical hemorrhage as reported by Al-Zirqi et al was 1.1%, which is higher than the present one.[8] The patients requiring transfusion of more than or equal to 1.5 litters in 24 hours in antepartum, intrapartum or postpartum period were included in our study, whereas Butwick et al evaluated the estimated blood loss in the patients receiving multiple transfusions.[12]  A retrospective analysis of transfusion management for obstetric hemorrhage in a Japanese obstetric center considered hemoglobin concentration <7 g/dL a criteria for blood product transfusion. [1]The visual estimation of blood loss can vary subjectively and it is known to underestimate the actual loss by 30-50%.[14] One-third of our patients were already in compromised state, so we did not consider the criteria of blood loss in our study.
The mean age of the patients receiving multiple transfusions was 26.4 years where as in studies by other authors showed that age more than 30 years had an increased risk of obstetrical hemorrhage.[8,12,13] They also found that patients with primi parity were more prone, which is different from the present study. Multiparity in this study was found in 73.7%, which could be due to early marriage and conception in our country. 
The physiological changes occurring during pregnancy makes obstetrics a very high risk field of medicine, which alerts the obstetricians that even normal low risk pregnancy, can become high risk at any time and vigilant supervision is required. In our study, majority of the women had unbooked (72.3%) unsupervised pregnancies�and some (n=5) also had severe anemia in labor at the time of presentation. It also highlights the fact that concept of routine and regular antenatal checkups has still not available�to every pregnant women.
The most common presentation of patients in our study was pregnancy induced hypertension and its complications which are consistent with the study by Butwick et al.[12] Around 30% (n=33) of patients presented in hemorrhagic shock. The etiological factors associated with multiple transfusions are post-partum hemorrhage and antepartum hemorrhage which are consistent with results from the studies assessing the risk factors associated with postpartum hemorrhage.[15-18]
Caesarean section and exploratory laparotomy was done in 51.8% patients, whereas 63% and 67% delivered by caesarean section in the studies by Butwick et al and Matsunaga S et al respectively.[12,13] The most common indication for multiple transfusions in this study was post-partum hemorrhage which is similar to the study by Matsunaga S et al.[13] Al-Zirqi et al and Butwick et al could not identify the indication for transfusion in one-third of cases.[8,12] 
The mean volume replacement given to these patients in 24 hours was 2.25 litres and the transfusion was done on the clinical assessment of blood loss and patients� condition, as in obstetrical emergencies one cannot wait for blood investigation report, although laboratory investigations were sent for these patients.[19] In present study, 76.8% of the patients had haemoglobin less than 7 gm% and required transfusion. In spite of multiple transfusions, 15.2% of patients had mortality and 39.3% required admission to ICU, with an average hospital stay of 10 days, however the study by Butwick et al reported 23% ICU admission and no maternal mortality.[12] Al-Zirqi et al in their study group had 245 ICU admissions; hysterectomy was done in six patients and two of them developed acute renal failure, whereas 33 patients of our study group had obstetrical hysterectomy and six developed acute renal failure.[8] 
Neonatal ICU (NICU) admissions in our study was in 21 babies and IUD was as high as 40 which is different from the study by Butwick et al where 25 babies required NICU care.[12] 
The limitation of this study is that it is an observational study with a small sample size and the obstetricians involved in managing such high risk patients had varying threshold for transfusion of blood and its components.
CONCLUSION
Patients� condition at admission is single most important factor often influencing the maternal and perinatal outcome. Prompt availability of blood and components in adequate quantity combined with management by a critical care team can help avert mortality in considerable number of cases. Long term consequences of multiple transfusions are not of serious concern in managing these life threatening complications. Adequate antenatal care for every pregnant woman is important. 
References
World Health Organization. Maternal Mortality in 2000. Estimates Developed by WHO, UNICEF and Geneva: WHO.2004.
 HYPERLINK "http://www.censusindia.gov.in/vital_statistics/SRS.../MMR_release_070711.pdf" www.censusindia.gov.in/vital_statistics/SRS.../MMR_release_070711.pdf
Baskett TF, Sternadel J. Maternal intensive care and near miss mortality in obstetrics. BJOG 1998;105:981-4.
Wen SW, Huang L, Liston R, Heaman M, Baskett T, Rusen ID. Severe maternal morbidity in Canada, 1991-2001. Can Med Assoc J 2005;173:759-64.
Brace V, Kernaghan D, Penney G. Learning from adverse clinical outcomes: major obstetric hemorrhage in Scotland, 2003-5. BJOG 2007;114:1388-96.
Zhang WH, Alexander S, Bouvier-Colle MH, Macfariane A, MOMS-B Group. Incidence of severe pre-eclampsia, postpartum hemorrhage and sepsis as a surrogate marker for severe maternal morbidity in a European population-based study: the MOMS-B survey. BJOG 2005;112:89-96
Waterstone M, Bewley s, Wolfe C. Incidence and predictor of severe obstetric morbidity: case-control study. BMJ 2001;322:1089-93.
Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B. Prevalence and risk factors of severe obstetric hemorrhage. BJOG 2008;115:1265-72.
Balki M, Dhumne S, Kasodekar S, Seaward G, Carvalho JC. Blood transfusion for primary postpartum hemorrhage: a tertiary care hospital review. Journal of Obstetrics andGynaecology Canada 2008;30(11):1002�7.
Drife J. Management of primary postpartum hemorrhage. BJOG1997;104(3):275-7.
James AH, Paglia MJ, Gernsheimer T, Grotegut C, Thames B. Blood component therapy in postpartum hemorrhage. Transfusion 2009; 49(11):2430�3.
Butwick AJ, Aleshi P, Fontaine M, Riley ET, Goodnough LT. Retrospective analysis of transfusion outcomes in pregnant patients at a tertiary obstetric center. Int J Obstet Anesth 2009;18:302-8.
Matsunaga S, Seki H, Ono Y, Matsumura H, Murayama Y, Takai Y et al. A retrospective analysis of transfusion management for obstetric hemorrhage in a Japanese obstetric center. ISRN Obstet Gynecol 2012;2012:854064.
Glover P. Blood loss at delivery: how accurate is your estimation? Aust J Midwifery2003;16:21-4.
Rouse DJ, MacPherson C, Landon M, Varner MW, Leveno KJ, Moawad AH et al. Blood transfusion and cesarean delivery. Obstet Gynecol 2006;108:891-7.
Reyal F, Sibony O, Oury JF, Luton D, Bang J, Blot P. Criteria for transfusion in severe post-partum hemorrhage: analysis of practice and risk factors. Eur J Obstet Gynecol Reprod Biol 2004;112:61-4.
Combs CA, Murphy EL, Laros Jr RK. Factors associated with hemorrhage in caesarean deliveries. Obstet Gynecol 1991;77;77-82.
Sheiner E, Sarid L, levy A, Seidman DS, Hallak M. Obstetric risk factors and outcome of pregnancies complicated with early post-partum hemorrhage: a population-based study. J Matern Fetal Neonatal Med 2005;18:149-54.
Nuttall GA, Stehling LC, Beighley CM, Faust RJ. Current transfusion practices of members of the American Society of Anesthesiologists:a survey. Anesthesiology 2003;99:1433-43.
Tables
Table 1: Demographic and obstetric profile (n=112)
Mean age (in years) = 26.4ParameterNumber of patientsPercentage (%)Antepartum9584.8 Status (n=112)
Booked3127.7Unbooked8172.3Parity (n=95)Primigravida2526.3Multigravida7073.7Period Of Gestation (n=95)26-34 Weeks3334.7e"35 Weeks6265.3Mode of delivery (n=u~�		�	�	�	�	�	�	�	M
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Indication of TransfusionNumber of patientsPercentage (%)Postpartum hemorrhage2825Antepartum hemorrhage2118.8Antepartum + postpartum hemorrhage98Coagulopathy1210.7HELLP1210.7Rupture uterus + Scar rupture16(12+4) 14.3Post-surgical complications65.4Others(severe anemia in labour-5,thrombocytopenia with severe anemia-2,thrombocytopenia with dengue-1)87.1
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ComorbidityNumber of patientsPercentage (%)Hysterectomy3329.5Wound infection1715.2ARF65.4LRTI65.4Pressure sore54.5Septicemia43.5










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