The effects of blood and blood products transfusion during postpartum haemorrhage remain to be demonstrated
The effects of blood and blood products transfusion during postpartum haemorrhage remain to be demonstrated
SOURCE
Williams CR, Huffstetler HE, Nyamtema AS, Larkai E, Lyimo M, Kanellopoulou A, Robertson L, Choi L, Alwy Al-beity FM. (2025)
Transfusion of blood and blood products for the management of postpartum haemorrhage
Cochrane Database of Syst Rev, 2, CD016168.
URL : https://pubmed.ncbi.nlm.nih.gov/39911088/
CLINICAL QUESTION
Blood loss of 500 mL or more within 24 hours after delivery defines postpartum haemorrhage (PPH). Transfusion of labile blood products may be considered for the management of PPH. The optimal transfusion strategy in the context of PPH is poorly defined.
BOTTOM LINE
What transfusion strategy (types of labile blood products and criteria for administration) improves maternal morbidity and mortality of PPH?
MAIN RESULTS
The threshold for initiating transfusion was not evaluated in the included studies. Regarding transfusion of 1 to 2 units of red blood cells compared with no transfusion : it may increase maternal morbidity, defined as mortality, admission to intensive care, major surgery, or organ failure (low level of evidence). It may increase intensive care admission (low level of evidence). No study evaluated mortality alone or adverse events. Regarding fibrinogen transfusion compared with placebo or no transfusion, the evidence on mortality is very uncertain (very low level of evidence). Regarding morbidity: there is probably little or no difference in intensive care admission (moderate level of evidence) and little or no difference in hysterectomy rates (low level of evidence). Evidence is very uncertain regarding embolisation and adverse events (very low level of evidence). Regarding cryoprecipitate transfusion compared with no cryoprecipitate transfusion, the evidence is very uncertain for mortality, morbidity, and adverse events (very low level of evidence). It was not possible to compare red blood cell transfusion with whole blood transfusion or with combined blood product transfusions. It was not possible to compare fresh frozen plasma combined with red blood cells and fibrinogen versus fresh frozen plasma with red blood cells alone. It was not possible to compare massive transfusion protocols with non-massive transfusion protocols.
CAVEATS
Available data on the effects of transfused whole blood and labile blood products during PPH are largely uncertain. Further studies are needed to determine transfusion modalities (threshold, quantity, products) and their effects on mortality, morbidity, and adverse events.
AUTHORS
Nekhili
SMUR, F-95500 Gonesse, France
Renard
Bataillon de marins-pompiers de Marseille, F-13233, Marseille, France
