Transfusion medicine handbook

6. Special Circumstances

6.7 Obstetric MHP Pathway

Obstetric patients with massive bleeding have important differences in their bleeding, coagulation and physiology from Code Crimson and Standard MHP patients. After the stat pack is given there should be a review. Coagulation deficits are uncommon in post-partum haemorrhage (PPH). However, placental abruption, pre-eclampsia and amniotic fluid embolism can be associated with low fibrinogen levels due to consumptive coagulopathies. Point of care testing (ROTEM/ TEG/ ClotPro) may be useful to determine the need for coagulation products, once the clinician has stopped the MHP and progressed to targeted transfusion.

During a PPH, fibrinogen falls before other coagulation factors. At term, the fibrinogen concentration is 4-6 g/L so replacement is required if the plasma level falls below 2 g/L. FFP has a low fibrinogen content and its early use can dilute the recipient’s fibrinogen level. Therefore, ‘Obstetric Pack 1’ includes cryoprecipitate.

Unnecessary use of FFP can lead to complications including TRALI and TACO.