Management and outcome of women requiring massive blood transfusion after childbirth: A cross-sectional study at Muhimbili National Hospital, Tanzania

Abstract

Introduction: Massive Obstetric Haemorrhage is the leading cause of maternal morbidity and mortality in sub-Saharan Africa. The management of obstetric haemorrhage requires a systematic and standardized approach to have a favourable maternal outcome. We describe the prevalence, aetiology, current management and outcomes of women with obstetric haemorrhage at Muhimbili National Hospital (MNH).

Method: A two-year retrospective review of cases with a diagnosis of obstetric haemorrhage whose gestation age was ≥ 24 weeks and blood loss ≥ 2L or required a blood transfusion of ≥ 4L. Data were analysed using SPSS version 23 and summarized into proportions as well as measures of central tendencies (mean and median) where appropriate. The case fatality rate was calculated using the number of deaths of women with obstetric haemorrhage to the total number of women who were diagnosed to have obstetric haemorrhage.

Results: The prevalence of women who had obstetric haemorrhage was 1%. Triggering of massive blood transfusion protocols by informing physician, blood bank, theatre team, pre-transfusion laboratory test and administration of intravenous fluid was performed in more than 98%. About 2.3% of patients received a proper ratio of blood and blood products during management. The percentage of patients with acute kidney injury (AKI), disseminated intravascular coagulopathy (DIC) and heart failure were 13.6%,7.0% and 4.3% respectively. Calcium gluconate was not administered to patients who had obstetric haemorrhage. During the study period the case fatality rate was 4.7%.

Conclusion: Management of patients with obstetric haemorrhage was deficient resulting in high rates of maternal mortality and morbidity. Standardised practice by adopting and use of massive transfusion protocol should reduce the adverse maternal outcomes.