Transfusion strategies in women during Major Obstetric Haemorrhage

Major obstetric haemorrhage is the most important cause of severe maternal morbidity. Observational studies on massive haemorrhage associated with trauma and surgery have shown an apparent survival advantage with the administration of high cumulative ratios plasma and platelets to red blood cells. However, these results may have been confounded due to reverse causation and do not take time-varying treatment and time-dependent confounding into account. Furthermore, some authors recently proposed that not the ratios between the transfused blood components determine the outcome, but rather the timing of transfusion of plasma and platelets. Administration of plasma and platelets early on in treatment would prevent and timely correct coagulopathy during ongoing blood loss, and would thus lead to more favourable outcomes.
The aim of this study is to determine the effect of early administration of plasma and platelets alongside RBCs on the clinical course of women with obstetric haemorrhage compared to administration at a later stage in treatment.
Women that received FFP and/or platelets alongside RBCs due to obstetric haemorrhage, in 2011 and 2012 in the Netherlands, will be identified by cross-referencing data from departments of blood transfusion services with data from local birth registers. Data on characteristics of and treatment of selected women will be collected by performing a chart review of patients. The effect of timing of transfusion of FFP and/or platelets in conjunction with RBC transfusion on maternal mortality and severe maternal morbidity will be determined by using an inverse probability weighted Cox proportional hazard model.

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