Postpartum hemorrhage is the leading cause of maternal death worldwide. Recent data from trauma patients and patients with hemorrhagic shock have suggested that an increased fresh frozen plasma:red blood cell (FFP:RBC) ratio may be of benefit in massive bleeding. We addressed this issue in cases of severe postpartum hemorrhage.
We reviewed data from all patients diagnosed with severe postpartum hemorrhage during a 4-year period (2006-2009). Patients who were treated with sulprostone and required transfusion within 6 hours of delivery were included in the study and were divided into 2 groups according to their response to sulprostone: bleeding controlled with sulprostone alone (sulprostone group) and bleeding requiring an additional advanced interventional procedure including arterial angiographic embolization and/or surgical procedures (arterial ligation, B-Lynch suture, or hysterectomy; intervention group). The requirement or no requirement for advanced procedures constituted the primary end point of the study. Propensity scoring was used to assess the effect of a high FFP:RBC ratio on bleeding control.
Among 12,226 deliveries during the study period, 142 (1.1%) were complicated by severe postpartum hemorrhage. Bleeding was controlled with sulprostone alone in 90 patients (63%). Advanced interventional procedures were required for 52 patients (37%). Forty-one patients were transfused with both RBCs and FFP. The FFP:RBC ratio increased over the study period (P < 0.001), from 1:1.8 at the start to 1:1.1 at the end of the study period. After propensity score modeling (inverse probability of treatment weighting), a high FFP:RBC ratio was associated with lower odds for advanced interventional procedures (odds ratio [95% confidence interval], 1.25 [1.07-1.47]; P = 0.008). There were no deaths, severe organ dysfunction, or other complications as a consequence of severe postpartum hemorrhage.
In this retrospective study, a higher FFP:RBC ratio was associated with a lower requirement for advanced interventional procedures in the setting of postpartum hemorrhage. The benefits of transfusion using a higher FFP:RBC ratio should be confirmed by randomized-controlled trials.
[Show abstract][Hide abstract] ABSTRACT: A 1:1:1 ratio of PRBCs, FFP, and platelets (PLT) has been advocated for trauma hemorrhage, but the effectiveness of this ratio for postpartum hemorrhage (PPH) is unknown. We created an in vitro hemodilutional model to investigate this strategy.
Blood from 20 parturients at term was diluted 50% with 0.9% NS. Diluted samples were reconstituted with 1:1 PRBC: FFP or 3:1 PRBC: FFP. In 10 samples, PLT were also added. Baseline, diluted, and reconstituted sample thromboelastographic values were compared.
Maximum amplitude (MA) was lower compared to baseline values in both groups after 50% dilution with NS (P < 0.001) and remained lower than baseline despite reconstitution with 3:1:0 or 1:1:0 PRBC: FFP: PLT (P < 0.0001) or 3:1:1 PRBC: FFP: PLT (P < 0.01). MA approached baseline (P = ns) in the samples with 1:1:1 PRBC: FFP: PLT.
The addition of PLT to 1:1 PRBC: FFP optimized MA in this in vitro hemodilutional model of PPH.
American journal of obstetrics and gynecology 11/2013; 210(4). DOI:10.1016/j.ajog.2013.11.029 · 4.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abnromalities of placentation, including placenta accreta, represent a major source of morbidity and mortality among women. Traditional management consists of peripartum hysterectomy at the time of delivery, although more conservative treatments have also been developed recently. In this review we describe the available literature describing the operative approach and considerations for management of women with placenta accreta.
BJOG An International Journal of Obstetrics & Gynaecology 01/2014; 121(2):163-70. DOI:10.1111/1471-0528.12524 · 3.45 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.