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Patient Blood Management in Pregnancy
Alexander Kaserer1, Clara Castellucci1, David Henckert1
1Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
Insights
Patient blood management (PBM) optimizes care during pregnancy and postpartum by screening for and treating anemia and iron deficiency. It also minimizes blood loss and uses transfusions judiciously to improve maternal and fetal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Anesthesiology
Background:
- Pregnancy and postpartum increase risks of iron deficiency and anemia, impacting maternal and fetal health.
- These conditions elevate the risk of obstetric hemorrhage, a leading cause of maternal mortality.
- Patient blood management (PBM) offers a structured approach to mitigate these risks.
Purpose of the Study:
- To review the principles and practices of PBM in the context of pregnancy, delivery, and the puerperium.
- To highlight the importance of early anemia and iron deficiency detection and treatment.
- To outline strategies for minimizing blood loss and optimizing transfusion practices in obstetric patients.
Main Methods:
- Review of current literature and guidelines on PBM in obstetrics.
- Emphasis on early screening for iron deficiency and anemia.
- Discussion of treatment modalities including iron supplementation and erythropoietin.
- Integration of transfusion and coagulation management strategies.
- Consideration of cell salvage techniques in obstetric hemorrhage.
Main Results:
- Early iron deficiency screening and treatment are crucial for improving maternal and fetal outcomes.
- A staged treatment regimen for anemia, including iron and potentially erythropoietin, is recommended.
- Proactive management of postpartum hemorrhage (PPH) through algorithms, uterotonics, tranexamic acid, and coagulation support is vital.
- Cell salvage is a beneficial adjunct in managing obstetric bleeding.
Conclusions:
- Implementing PBM principles in obstetrics can significantly reduce maternal morbidity and mortality.
- A multidisciplinary approach encompassing screening, treatment, hemorrhage prevention, and judicious transfusion is essential.
- Tailored PBM strategies are key to optimizing patient care throughout pregnancy and postpartum.
Background:
Patient blood management (PBM) is a multidisciplinary and patient-centered treatment approach, comprising the detection and treatment of anemia, the minimization of blood loss, and the rational use of allogeneic transfusions. Pregnancy, delivery, and the puerperium are associated with increased rates of iron deficiency and anemia, which correlates with worse maternal and fetal outcomes and places pregnant women at increased risk of obstetric hemorrhage.
Summary:
Early screening for iron deficiency before the onset of anemia, as well as the use of oral and intravenous iron to treat iron deficiency anemia, has been shown to be beneficial. Anemia in pregnancy and the puerperium should be treated according to a staged regimen, administering either iron alone or in combination with an off-label use of human recombinant erythropoietin in selected patients. This regimen should be tailored to the needs of each individual patient. Postpartum hemorrhage (PPH) accounts for up to one-third of maternal deaths in both developing and developed countries. Bleeding complications should be anticipated and blood loss reduced by interdisciplinary preventive measures and individually tailored care. It is recommended that facilities have a PPH algorithm, primarily focusing on prevention through use of uterotonics, but also incorporating early diagnosis of the cause of bleeding, optimization of hemostatic conditions, timely administration of tranexamic acid, and integration of point-of-care tests to support the guided substitution of coagulation factors, alongside standard laboratory tests. Additionally, cell salvage has proven beneficial and should be considered for various indications in obstetrics including hematologic disturbances, as well as various forms of placental disorders.
Key Message:
This article reviews PBM in pregnancy, delivery, and the puerperium. The concept comprises early screening and treatment of anemia and iron deficiency, a transfusion and coagulation algorithm during delivery, as well as cell salvage.
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