Contemporary patient blood management in abnormally invasive placenta at a tertiary centre, with a focus on the role of the transfusion practitioner.

Abstract

Background and objectives: Abnormally invasive placenta (AIP) refers to a rare (<0.2% of live births) spectrum of obstetric disorders characterized by dysfunctional placental implantation, associated with major obstetric haemorrhage at delivery. There is limited evidence regarding effective patient blood management (PBM) strategies peripartum. In this study, we describe the clinical characteristics and outcomes of AIP at our centre over a 5-year period, with a particular focus on PBM.

Materials and methods: We carried out a retrospective review of the electronic medical records for all (34) women with AIP who underwent delivery between January 2019 and November 2023.

Results: At delivery, the median age was 37 years (range 25-52) and the median gestational age was 36 weeks (range 29-39). All deliveries were by caesarean section and coordinated through a multidisciplinary approach with direct input from a transfusion practitioner (TP) during delivery. The median estimated blood loss was 4.7 L (range 0.7-14). Thirty-two (94%) patients received packed red blood cells (median 6 units, range 0-23). Red cell salvage (RCS) was performed in 29 (85%). There were no maternal or neonatal deaths. Seventeen (50%) patients underwent hysterectomy and 17 (50%) required intensive therapy unit admission. There was no maternal red cell alloimmunization or acute transfusion reactions.

Conclusion: Our data reinforce the importance of effective PBM strategies for AIP by demonstrating favourable survival outcomes with a hysterectomy rate of 50% using a multidisciplinary approach with direct involvement by a TP and utilizing RCS.