An observational study of the fresh frozen plasma: red blood cell ratio in postpartum hemorrhage.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

• Authors: Pierre Pasquier, Etienne Gayat, Thibaut Rackelboom, Julien La Rosa, Abeer Tashkandi, Antoine Tesniere, Julie Ravinet, Jean-Louis Vincent, Vassilis Tsatsaris, Yves Ozier, François Goffinet, Alexandre Mignon
• Journal: Anesthesia and analgesia (Anesth Analg) Vol. 116 Issue 1 Pg. 155-61 (Jan 2013) ISSN: 1526-7598 [Electronic] United States
• PMID: 23223094 (Publication Type: Journal Article)

Chemical References

• Menstruation-Inducing Agents
• sulprostone
• Dinoprostone

Topics

• Adult
• Anesthesia, Obstetrical
• Angiography
• Birth Weight
• Cesarean Section
• Dinoprostone (analogs & derivatives, therapeutic use)
• Embolization, Therapeutic
• Erythrocyte Count
• Erythrocytes (physiology)
• Female
• Humans
• Infant, Newborn
• Menstruation-Inducing Agents (therapeutic use)
• Odds Ratio
• Plasma
• Postpartum Hemorrhage (blood, surgery, therapy)
• Pregnancy
• Propensity Score
• Risk Factors