2. Pregnancy and blood loss
Pregnant women has an increased blood volume of about
20-30%
Blood volume estimation - about 100ml/kg
60kg = 6 litres of blood
As such
1.0L of blood loss in a pregnant woman is not the same as 1.0L of
blood loss in a non-pregnant woman
1.0L of blood loss in a 80kg woman is different from a 40kg woman
3. Lost of circulating volume in
obstetrics
Circulating
volume lost
Signs
Up to 0.5L-1.0L Mild increase in PR -
1.0-1.5L Increase PR
Increase breathing
Slight fall in BP (80-100
mmHg SBP)
Use crystalloids to replace fluid
loss
1.5-2.0L Use colloids to replace
30-40%
(Over 2 L)
BP drops Need a blood transfusion in
addition to crystalloids
>40% Immediate life threatening Blood transfusion is required
immediately
Need rapid transfusion
Referring to a normal healthy pregnant woman i.e. not anaemic, etc
4. Vital signs
When abnormal in the context of haemorrhage,
they are useful in assessing the severity of the
hypovolemic shock
When normal however, they are not reliable in
assessing the severity of the hypovolemic shock
Remember that a drop in BP is a late sign of
hypovolaemia! Patient has lost at least 30% of her blood
volume!!!
Should not rely on BP to assess volume loss!!!
5. <30% blood loss - Red cell transfusion not necessary unless:
Pre-existing anaemia
Reduced cardiorespiratory reserve
Ongoing blood loss
6. Loss of circulating volume
Replacement with crystalloids - every ml blood loss, 3ml
crystalloids needed
3 to 1 ratio
Replacement with colloids – every ml blood loss, 1.5 ml
colloids needed
3 to 2 ratio
7. Blood transfusion
Whole blood vs Packed cells
No data to suggest that the use of whole blood, even
“fresh” is associated with better outcome in acute blood
loss
Usually used in exchange transfusion
For acute blood loss,
Give specific blood components as required:
Packed cells
Platelet concentrate
FFP
Cryoprecipitate - Factor I, VIII, vWF (+ XIII, fibronectin)
Cryosupernatant
8. Rapid blood transfusion in life-
threatening condition
BP cuff (high-pressure infusion devices)
No blood filters
With warmers
O-ve blood
9. DIVC in obstetrics
Consumption coagulopathy (depletion of
platelets and coagulation factors) that leads to
further haemorrhage
Can be due to:
Massive bleeding (e.g. APH, PPH, abruption)
Sepsis
Amniotic fluid embolism
Eclampsia
IUD
10. DIVC
Treat the underlying cause (sepsis, massive blood
loss, severe vessel injury, toxins)
Transfuse platelet if bleeding associated with
thrombocytopaenia. Aim for > 50 x 109 /L (C, IV)
Platelets should not be allowed to fall <50 x 109 in
acutely bleeding patient
11. DIVC
If bleeding continues after large volumes red cell
and platelets have been transfused, FFP and
cryoprecipitate may be given (depending on
protocol e.g. after 10 units of RBCs, abnormal
coagulation profile, etc)
Transfuse FFP and cryoprecipitate so that the PT
and APTT ratios are within 1.5 and a fibrinogen
level of > 1.0 g/ L
12. Adequate resuscitation from shock - most
important in preventing coagulopathy
No evidence that prophylactic regimes
prevents or reduce transfusion
requirements
13. Massive Blood Loss
Replacement of total blood volume (5 L) within
24 hours
Loss of 50% blood volume in less than or equal
to 3 hours
150ml/ min blood loss (Loss of half the blood
volume in 20 minutes)
Transfusion of more than 20 units of
erythrocytes