Life-threatening postpartum hemorrhage (≥ 5000 mL): a single center experience

Abstract

Objectives: To investigate the etiology, interventions and outcome of life-threatening postpartum hemorrhage (PPH) (≥ 5000 mL). Material and methods: Retrospective analysis was performed on the clinical data of 42 patients with life-threatening PPH in Peking University Third Hospital from January 2010 to December 2019. According to the causes of PPH, 35 patients were divided into the placenta accrete spectrum (PAS) group and seven patients into the uterine atony group. Results: Compared with the uterine atony group, the gravidity, parity, times of cesarean section, abortion and intrau-terine operation of the PAS group were significantly higher, but the gestational age of delivery and the birth weight of newborn were significantly lower (33.35 ± 3.94 weeks vs 37.31 ± 1.93 weeks; 2228.29 ± 840.49 g vs 2809.00 ± 500.99 g; p < 0.05). For all the patients, the transfusion volume of packed red blood cell (PRBCs), fresh frozen plasma (FFP) and platelets were respectively 23.49 ± 8.42 U, 2345.24 ± 826.16 mL and 0.81 ± 1.19 U, the ratio was basically conformed to the recommended massive transfusion protocol (MTP) (1:1:1). The catheter placement time in the PAS group was significantly longer (7.88 ± 6.05 days vs 3.86 ± 0.90 days, p < 0.05). There were no significant differences in complications and maternal outcomes. No maternal deaths. Conclusions: Placenta accrete spectrum (PAS) is the most important cause of life-threatening PPH. For these patients, MTP is effective, multidisciplinary cooperation and management lead to a good prognosis.