The indicators for early blood transfusion in patients with placental abruption with intrauterine fetal death: a retrospective review
Abstract Background Placental abruption (PA) with intrauterine fetal death (IUFD) is associated with a high risk of postpartum hemorrhage (PPH) resulting from severe disseminated intravascular coagulation (DIC). Therefore, blood products that are sufficient for coagulation factor replacement must be...
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-022-05187-9 |
| _version_ | 1828127813689933824 |
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| author | Yasuko Sano Michi Kasai Satoru Shinoda Etsuko Miyagi Shigeru Aoki |
| author_facet | Yasuko Sano Michi Kasai Satoru Shinoda Etsuko Miyagi Shigeru Aoki |
| author_sort | Yasuko Sano |
| collection | DOAJ |
| description | Abstract Background Placental abruption (PA) with intrauterine fetal death (IUFD) is associated with a high risk of postpartum hemorrhage (PPH) resulting from severe disseminated intravascular coagulation (DIC). Therefore, blood products that are sufficient for coagulation factor replacement must be prepared, and delivery should occur at referral medical institutions that are equipped with sufficient blood products and emergency transfusion protocols. We retrospectively reviewed the records of patients with PA and IUFD (PA-IUFD) to identify possible factors that may indicate the need for early blood transfusion and investigated whether the Japanese scoring system for PPH can be applied in such cases. Methods We used a database of 16,058 pregnant patients who delivered at Yokohama City University Medical Center between January 2000 and February 2016. Thirty-three patients were diagnosed with PA-IUFD before delivery and categorized into two groups–blood transfusion and non-transfusion–to compare the maternal characteristics and pregnancy outcomes. Results In patients with PA-IUFD, the transfusion group exhibited significantly more blood loss; lower fibrinogen levels and platelet counts; higher levels of fibrin degradation products (FDP), D-dimer, and prothrombin time; and a tendency for tachycardia on admission, compared to the non-transfusion group. Many patients in the transfusion group had normal fibrinogen levels on admission but later displayed markedly decreased fibrinogen levels. The Japan Society of Obstetrics and Gynecology (JSOG) DIC score was significantly higher in the transfusion than in the non-transfusion group. Conclusions In PA-IUFD, the fibrinogen level, platelet count, D-dimer, FDP, heart rate, and JSOG DIC score on admission may indicate the need for blood transfusion. However, even with normal fibrinogen levels on admission, continuous monitoring is indispensable for identifying progressive fibrinogen reductions in patients with PA-IUFD. |
| first_indexed | 2024-04-11T15:55:13Z |
| format | Article |
| id | doaj.art-f3e55bae5bab4becaa69418842935617 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-04-11T15:55:13Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-f3e55bae5bab4becaa694188429356172022-12-22T04:15:11ZengBMCBMC Pregnancy and Childbirth1471-23932022-11-012211810.1186/s12884-022-05187-9The indicators for early blood transfusion in patients with placental abruption with intrauterine fetal death: a retrospective reviewYasuko Sano0Michi Kasai1Satoru Shinoda2Etsuko Miyagi3Shigeru Aoki4Perinatal Center for Maternity and Neonates, Yokohama City University Medical CenterPerinatal Center for Maternity and Neonates, Yokohama City University Medical CenterDepartment of Biostatistics, Yokohama City University School of MedicineDepartment of Obstetrics and Gynecology, Yokohama City University School of MedicinePerinatal Center for Maternity and Neonates, Yokohama City University Medical CenterAbstract Background Placental abruption (PA) with intrauterine fetal death (IUFD) is associated with a high risk of postpartum hemorrhage (PPH) resulting from severe disseminated intravascular coagulation (DIC). Therefore, blood products that are sufficient for coagulation factor replacement must be prepared, and delivery should occur at referral medical institutions that are equipped with sufficient blood products and emergency transfusion protocols. We retrospectively reviewed the records of patients with PA and IUFD (PA-IUFD) to identify possible factors that may indicate the need for early blood transfusion and investigated whether the Japanese scoring system for PPH can be applied in such cases. Methods We used a database of 16,058 pregnant patients who delivered at Yokohama City University Medical Center between January 2000 and February 2016. Thirty-three patients were diagnosed with PA-IUFD before delivery and categorized into two groups–blood transfusion and non-transfusion–to compare the maternal characteristics and pregnancy outcomes. Results In patients with PA-IUFD, the transfusion group exhibited significantly more blood loss; lower fibrinogen levels and platelet counts; higher levels of fibrin degradation products (FDP), D-dimer, and prothrombin time; and a tendency for tachycardia on admission, compared to the non-transfusion group. Many patients in the transfusion group had normal fibrinogen levels on admission but later displayed markedly decreased fibrinogen levels. The Japan Society of Obstetrics and Gynecology (JSOG) DIC score was significantly higher in the transfusion than in the non-transfusion group. Conclusions In PA-IUFD, the fibrinogen level, platelet count, D-dimer, FDP, heart rate, and JSOG DIC score on admission may indicate the need for blood transfusion. However, even with normal fibrinogen levels on admission, continuous monitoring is indispensable for identifying progressive fibrinogen reductions in patients with PA-IUFD.https://doi.org/10.1186/s12884-022-05187-9Blood transfusionFetal deathFibrinogenPlacental abruptionPregnancy |
| spellingShingle | Yasuko Sano Michi Kasai Satoru Shinoda Etsuko Miyagi Shigeru Aoki The indicators for early blood transfusion in patients with placental abruption with intrauterine fetal death: a retrospective review BMC Pregnancy and Childbirth Blood transfusion Fetal death Fibrinogen Placental abruption Pregnancy |
| title | The indicators for early blood transfusion in patients with placental abruption with intrauterine fetal death: a retrospective review |
| title_full | The indicators for early blood transfusion in patients with placental abruption with intrauterine fetal death: a retrospective review |
| title_fullStr | The indicators for early blood transfusion in patients with placental abruption with intrauterine fetal death: a retrospective review |
| title_full_unstemmed | The indicators for early blood transfusion in patients with placental abruption with intrauterine fetal death: a retrospective review |
| title_short | The indicators for early blood transfusion in patients with placental abruption with intrauterine fetal death: a retrospective review |
| title_sort | indicators for early blood transfusion in patients with placental abruption with intrauterine fetal death a retrospective review |
| topic | Blood transfusion Fetal death Fibrinogen Placental abruption Pregnancy |
| url | https://doi.org/10.1186/s12884-022-05187-9 |
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