(779) Predictors for Massive Transfusion in Cases of Postpartum Hemorrhage

Introduction: Postpartum hemorrhage is the leading cause of maternal mortality in Japan as well as a major cause of maternal death worldwide. Rapid transfusion is often required in severe cases; however, the amount of bleeding is often inaccurate, necessitating the identification of predictors for massive transfusion. Although various predictors, including the shock index (SI), have been studied in Japan, no consensus has been reached. Therefore, we aimed to investigate the predictors for massive transfusion in cases of postpartum hemorrhage.

Methods: Patients who were transported to our emergency center within 24 h after delivery with a bleeding volume of 1000 ml or more between January 1, 2013, and March 31, 2023, were included. Patients who were in cardiac arrest upon arrival, who received pre-hospital transfusions, or for whom relevant data were missing were excluded.

Results: Massive transfusion was defined as the administration of 10 or more units of red blood cells(1U＝280ml) or fresh frozen plasma(1U＝240ml). The patients were divided into two groups based on whether massive transfusion was needed. Patient characteristics, causes of bleeding, blood data, and treatments were compared between the groups, and a multivariate analysis was performed.Sixty-nine patients were included, 22 of whom were in the massive transfusion group.Compared to the non-massive transfusion group, the transfusion group had a significantly higher SI (1.2 vs 1.02, P < 0.01) and lactate levels (5.2 vs 3.1 mmol/L, P = 0.012) and a significantly lower fibrinogen levels (149 vs. 271 mg/dL, P < 0.01). Multivariate analysis showed that SI (odds ratio: 9.94, 95% CI: 1.24-79.9) and fibrinogen level (odds ratio: 0.99, 95% CI: 0.98-0.99) were associated with massive transfusion.

Conclusions: SI and fibrinogen level on admission were associated with massive transfusion in cases of postpartum hemorrhage.