Obstetrical aspects of the National Blood Donation and Blood Saving Program

The aims of the National Blood Donation and Blood Saving Program are to support the rational and judicious utilization of blood products and abolish irrational transfusion policy to improve patient safety. In addition to the general principles, this program has got some special obstetrical aspects. Obstetrical, especially the postpartum haemorrhages belong to the leading causes of maternal mortality worldwide. In developed countries, a trend in increasing incidence can be observed. Preparing for delivery includes some important elements such as optimization of hemoglobin level, routinely applied prophylactic or therapeutic iron supplementation and early screening and comprehensive care of patients with high risk of obstetrical bleeding. The main causes of peripartum bleeding are abruptio placentae, placenta praevia, uterine atony, retained tissue in the uterus, trauma during delivery, and haemostatic disorders or their combinations. To prevent postpartum bleeding, it is important to use the active management of the third stage of labour including prophylactic utilization of uterotonics as an essential element. Utilization of blood salvage techniques with adequate indications may be considered in cases of cesarean section or postpartum haemorhage. In cases of obstetrical haemorrhage, management of surgical bleeding has the main priority by the obstetrician. Secondary coagulopathy associated with massive bleeding should be managed by viscoelastic test-guided, individualized and factor concentrate-based algorithm, however, pregnancy-specific reference and target ranges must be used that are different from the non-pregnancy values. Obstetrical bleedings belong to the potentially preventable causes of death. Hopefully, the implementation of the National Blood Donation and Blood Saving Program in the field of obstetrics can decrease the associated morbidity and mortality further. Orv Hetil. 2020; 161(37): 1588-1598.