• L Green, M Knight, F M Seeney, C Hopkinson, P W Collins, R E Collis, Nab Simpson, A Weeks, and S S Stanworth.
• Barts Health NHS Trust & NHS Blood and Transplant, London, UK.
• BJOG. 2016 Dec 1; 123 (13): 2164-2170.

ObjectiveTo ascertain the incidence of massive transfusion (MT) in obstetrics in the UK, and describe its management and clinical outcomes.DesignA population-based cross-sectional study conducted through the UK Obstetric Surveillance System (UKOSS).SettingsAll UK hospitals with consultant-led maternity units.PopulationAny pregnant woman at ≥20 weeks of gestation receiving ≥8 units of red blood cells within 24 hours of giving birth, from July 2012 to June 2013.MethodsProspective case identification through the monthly mailing of UKOSS.ResultsWe identified 181 women who had undergone MT, making the estimated incidence of MT associated with postpartum haemorrhage (PPH) 23 per 100 000 maternities (95% confidence interval 19-26) per year. The median estimated blood loss was 6 l (interquartile range 4.5-8.0 l). The majority of women presented outside working hours (63%), 40% had had previous caesarean sections and 3% had normal vaginal births without risk factors. The main cause for MT was uterine atony (40%) and the main mode of birth was caesarean section (69%). Of the 181 women, 15 received >20 units of red blood cells. In total, 45% of women underwent hysterectomy, and among all causes of PPH, placenta accreta had the highest hysterectomy rate. Two women died, 82% were admitted to intensive care/high-dependency units, and 28% developed major morbidities.ConclusionMassive transfusion due to PPH is associated with high rates of morbidity and hysterectomy. Clinical and research efforts should focus on approaches to recognise and optimise timely resuscitation and management of these severe cases.Tweetable AbstractMassive transfusion due to postpartum haemorrhage is associated with high rates of morbidity and hysterectomy.© 2015 Royal College of Obstetricians and Gynaecologists.

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