Available online 21 March 2024, 102774

Author links open overlay panel, , , , , , , ABSTRACTINTRODUCTION

red blood cell (RBC) transfusions are of utmost importance in the management of severe post-partum haemorrhage. Although the recommendations for blood transfusion protocols are regularly issued, there are significant differences in management depending on the context and the medical teams involved.

OBJECTIVE

to determine during the first 24 hours, the clinical and biological factors associated with the decision for RBC transfusion during severe PPH (≥1000 mL) for vaginal and caesarean deliveries.

STUDY DESIGN

monocentric retrospective study conducted in a tertiary care university maternity unit (CHI-Creteil) including all parturients from November 23th 2018 to 31th December 2020 with severe PPH (≥1000 mL).

RESULTS

over the study period, we reported 7103 deliveries, out of which 682 were complicated by PPH (9.6%) with 200 cases of PPH ≥1000 mL (2.8%). In our study, 40% of patients (80/200) required a RBC transfusion”. After multivariate analysis, severe PPH caused by placental abruption, uterine rupture or placental implantation disorders (aOR = 3.48 IC95 [1.27-9.52], p<0.001), estimated blood loss ≥1500 mL (aOR = 9.60 IC95 [3.69-24.95], p<0. 001), invasive measures such as uterine balloon tamponade, arterial ligation and uterine packing (aOR = 4.15 IC95 [1.80-9.61], p<0.001), pre-labor hemoglobin <10 g/dL (aOR =4.88 IC95 [1.57-15.15], p<0.001) or abnormal biological results in the acute phase (including hemoglobin <7.0 g/dL and/or fibrinogen <2 g/L and/or platelets <100G/L) (aOR =3,56 IC95 [1,05-12,10], p<0.001) were significantly and independently associated with the decision to initiate RBC transfusions.

CONCLUSIONS

in a monocentric retrospective study including 200 consecutive cases of severe PPH (≥1000mL) we identified groups of clinical and biological factors directly accessible to clinicians, significantly and independently associated with RBC transfusion in the first 24 hours of management.

Section snippetsINTRODUCTION

Severe postpartum haemorrhage (PPH) is defined as blood loss ≥1000 mL within the first 24 hours of delivery [1]. A systematic review of the literature including 123 databases between 1994 and 2008 estimates an incidence of 2.8% for severe PPH [2], making it the most frequent complication of childbirth. Uterine atony represents the main cause of PPH, responsible for 50 to 80% of PPH regardless of the type of delivery [3]. The incidence of maternal mortality due to PPH is decreasing in France,

METHODS

This is a monocentric retrospective study including all parturients from November 23th 2018 to 31th December 2020 who presented with severe PPH, in a tertiary care university maternity unit (CHI-Créteil). We chose to analyze 200 consecutive cases of severe PPH with no a priori power test. PPH cases are systematically recorded in a computerized database (APPROACH). The inclusion criteria were all deliveries (live births, intrauterine fetal death or termination of pregnancy) after 22 weeks of

RESULTS

Over the study period, we reported 7103 deliveries after 22 weeks of gestational age, out of which 682 were complicated by PPH (9.6%) and 200 cases presented with PPH ≥1000 mL (2.8%) constituting the study population (Figure 1). Among the 200 consecutive cases of PPH, we report 4 PPH occurring in the context of of intra uterine fetal death and no case occurring in the context of termination of pregnancy. No maternal death was reported in the study population. No patient had a history of

DISCUSSION

Our main objective was to identify the main clinical and biological determinants which are available to clinicians and associated with RBC transfusion in the first 24 hours of management of severe PPH. Three highly haemorrhagic causes (placental abruption, uterine rupture, placental implantation disorders), estimated blood loss ≥1500 mL, invasive measures (uterine balloon tamponade, arterial ligation and uterine packing), a pre-labour hemoglogin <10 g/dL, pathological biological results in the

CONCLUSION

In a monocentric retrospective study including 200 consecutive cases of severe PPH (≥1000 mL) we identified groups of clinical and biological items directly accessible to clinicians (highly haemorrhagic causes, estimated blood loss ≥1500 mL, invasive measures, a pre-labour hemoglobin <10 g/dL, pathological biological results), significantly and independently associated with the RBC transfusion decision in the first 24 hours of management.

FUNDING

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of competing interest

The authors declared no conflict of interest.

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© 2024 Published by Elsevier Masson SAS.