The indicators for early blood transfusion in patients with placental abruption with Intrauterine Fetal Death: A retrospective review

Background: Placental abruption (PA) with intrauterine fetal death (IUFD) is associated with a high risk of postpartum hemorrhage (PPH) resulting from severe disseminated intravascular coagulation (DIC). Therefore, sufficient blood products must be prepared for coagulation factor replacement and deliveryat higher medical institutions,. We retrospectively reviewed patients with PA and IUFD（PA-IUFD） to identify possible factors that may indicate the need for early blood transfusion and investigated whether the Japanese scoring system for PPH can be applied in such cases. Methods: : We used a database of 16,058 pregnant patients who delivered at Yokohama City University Medical Center between January 2000 and February 2016. Thirty-three patients were diagnosed with PA-IUFD before delivery and categorized into two groups–blood transfusion and non-transfusion–to compare the maternal characteristics and pregnancy outcomes. Results: : In patients with PA-IUFD, the transfusion group exhibited significantly more blood loss, lower fibrinogen levels and platelet count, higher fibrin degradation products (FDP), D-dimer, and prothrombin time, and a tendency for tachycardia on admission compared to the non-transfusion group. Many patients in this group bore normal fibrinogen levels on admission but later displayed markedly decreased fibrinogen levels. The Japan Society of Obstetrics and Gynecology (JSOG) DIC score was significantly higher in the transfusion than the non-transfusion group. Conclusions: : In PA-IUFD, fibrinogen level, platelet count, D-dimer, FDP, heart rate, and JSOG DIC score on admission may indicate the need for blood transfusion. However, even with normal fibrinogen levels on admission, continuous monitoring is indispensable for identifying progressive fibrinogen reductions in patients with PA-IUFD.