Association of Timing of Plasma Transfusion With Adverse Maternal Outcomes in Women With Persistent Postpartum Hemorrhage

被引：20

作者：

Henriquez, Dacia D. C. A. ^{[1
,2
,3
]}

Caram-Deelder, Camila ^{[1
,2
]}

le Cessie, Saskia ^{[2
,4
]}

Zwart, Joost J. ^{[5
]}

van Roosmalen, Jos J. M. ^{[3
,6
]}

Eikenboom, Jeroen C. J. ^{[7
]}

So-Osman, Cynthia ^{[8
]}

van de Watering, Leom. G. ^{[8
]}

Zwaginga, Jaap Jan ^{[1
,9
]}

Koopman-van Gemert, Ankie W. M. M. ^{[10
]}

Bloemenkamp, Kitty W. M. ^{[1
,11
]}

van der Bom, Johanna G. ^{[1
,2
]}

Bank, Cock M. C. ^{[12
]}

Snuif-de Lange, Yvette S. ^{[12
]}

van Gammeren, Adriaan J. ^{[13
]}

Papatsonis, Dimitri N. M. ^{[13
]}

Klinkspoor, Harriet ^{[14
]}

Kok, Marjolein ^{[14
]}

de Boer, Bauke A. ^{[15
]}

Langenveld, Josje ^{[16
]}

Leers, Mathie P. G. ^{[16
]}

Diris, Jart H. C. ^{[17
]}

Kok, Rene D. ^{[17
]}

Engbers, Paula ^{[18
]}

Hanssen, Marjo J. C. P. ^{[18
]}

van Wijngaarden, Wim J. ^{[19
]}

Schippers, Daniela H. ^{[20
]}

van der Stappen, Josw. J. ^{[20
]}

Hasaart, Tom H. M. ^{[21
]}

van de Kerkhof, Daan H. ^{[21
]}

de Kok, Jacques B. ^{[22
]}

van Unnik, Gijs A. ^{[23
]}

Kortlandt, Wouter ^{[24
]}

Schuitemaker, Nicow. E. ^{[24
]}

Delemarre, Friso M. C. ^{[25
]}

van Duijnhoven, Hans L. P. ^{[25
]}

Duvekot, Hans J. ^{[26
]}

Hogenboom, Sietske ^{[27
]}

Kleiverda, Gunilla ^{[27
]}

van Etten-van Hulst, Mylene J. W. ^{[28
]}

Mirani-Oostdijk, Karin Pagano ^{[28
]}

van Kampen, Corine ^{[29
]}

Weinans, Martin J. N. ^{[30
]}

Adriaanse, Henk J. ^{[31
]}

Huisjes, Anjoke J. M. ^{[31
]}

Frasa, Marieke A. M. ^{[32
]}

Keuren, Jeffrey F. W. ^{[32
,74
]}

van Meir, Claudia A. ^{[32
]}

Feitsma, Hanneke ^{[33
]}

Hudig, Francisca ^{[33
]}

机构：

[1] Leiden Univ, Dept Obstet, Med Ctr, Leiden, Netherlands

[2] Leiden Univ, Med Ctr, Jon J van Rood Ctr Clin Transfus Res, Sanquin, Plesmanlaan 1a, NL-2333 BZ Leiden, Netherlands

[3] Leiden Univ, Dept Clin Epidemiol, Med Ctr, Leiden, Netherlands

[4] Leiden Univ, Dept Biomed Data Sci, Med Ctr, Leiden, Netherlands

[5] Deventer Hosp, Dept Obstet & Gynecol, Deventer, Netherlands

[6] Vrije Univ, Athena Inst, Amsterdam, Netherlands

[7] Leiden Univ, Div Thrombosis & Hemostasis, Dept Internal Med, Med Ctr, Leiden, Netherlands

[8] Sanquin Blood Bank, Unit Transfus Med, Leiden, Netherlands

[9] Leiden Univ, Dept Immunohematol & Blood Transfus, Med Ctr, Leiden, Netherlands

[10] Albert Schweitzer Hosp, Dept Anesthesiol, Dordrecht, Netherlands

[11] Univ Med Ctr Utrecht, Wilhelminas Children Hosp, Div Woman & Baby, Dept Obstet,Birth Ctr, Utrecht, Netherlands

[12] Admiraal de Ruyter Hosp, Goes, Netherlands

[13] Amphia Hosp, Breda, Netherlands

[14] Amsterdam Med Ctr, Amsterdam, Netherlands

[15] Atalmedial, Leiden, Netherlands

[16] Atrium Med Ctr, Heerlen, Netherlands

[17] Bernhoven Hosp, Uden, Netherlands

[18] Bethesda Hosp, Hoogeveen, Netherlands

[19] Bronovo Hosp, The Hague, Netherlands

[20] Canisius Wilhelmina Hosp, Nijmegen, Netherlands

[21] Catharina Hosp, Eindhoven, Netherlands

[22] Deventer Hosp, Deventer, Netherlands

[23] Diaconessen Hosp, Leiden, Netherlands

[24] Diakonessen Hosp, Utrecht, Netherlands

[25] Elkerliek Hosp, Helmond, Netherlands

[26] Erasmus MC, Rotterdam, Netherlands

[27] Flevo Hosp, Almere, Netherlands

[28] Fransiscus Hosp, Roosendaal, Netherlands

[29] Gelderse Vallei Hosp, Ede, Netherlands

[30] Gelderse Vallei Hosp, Apeldoorn, Netherlands

[31] Gelre Hosp, Apeldoorn, Netherlands

[32] Groene Hart Hosp, Gouda, Netherlands

[33] Haga Hosp, The Hague, Netherlands

[34] Hosp Grp Twente, Almelo, Netherlands

[35] Hosp Rivierenland Tiel, Tiel, Netherlands

[36] Ikazia Hosp, Rotterdam, Netherlands

[37] Isala Clin, Zwolle, Netherlands

[38] Lange Land Hosp, Zoetermeer, Netherlands

[39] Maas Hosp Pantein, Boxmeer, Netherlands

[40] Maasstad Hosp, Rotterdam, Netherlands

[41] Maastricht Univ, Med Ctr, Maastricht, Netherlands

[42] Martini Hosp, Groningen, Netherlands

[43] Maxima Med Ctr, Veldhoven, Netherlands

[44] Meander Med Ctr, Amersfoort, Netherlands

[45] Med Ctr Alkmaar, Alkmaar, Netherlands

[46] Med Ctr Haaglanden, The Hague, Netherlands

[47] Med Ctr Leeuwarden, Leeuwarden, Netherlands

[48] Med Ctr Twente, Enschede, Netherlands

[49] Medlon, Almelo, Netherlands

[50] Onze Lieve Vrouw Hosp, Amsterdam, Netherlands

来源：

JAMA NETWORK OPEN | 2019年 / 2卷 / 11期

关键词：

PROPENSITY SCORE ANALYSIS; HOSPITAL CARDIAC-ARREST; FIBRINOGEN CONCENTRATE; MULTIPLE IMPUTATION; TRACHEAL INTUBATION; TRANEXAMIC ACID; DOUBLE-BLIND; BALANCE; COAGULOPATHY; MANAGEMENT;

D O I：

10.1001/jamanetworkopen.2019.15628

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

IMPORTANCE Early plasma transfusion for women with severe postpartum hemorrhage (PPH) is recommended to prevent coagulopathy. However, there is no comparative, quantitative evidence on the association of early plasma transfusion with maternal outcomes. OBJECTIVE To compare the incidence of adverse maternal outcomes among women who received plasma during the first 60 minutes of persistent PPH vs women who did not receive plasma for similarly severe persistent PPH. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study used a consecutive sample of women with persistent PPH, defined as PPH refractory to first-line measures to control bleeding, between January 1, 2011, and January 1, 2013. Time-dependent propensity score matching was used to select women who received plasma during the first 60 minutes of persistent PPH and match each of them with a woman who had shown the same severity and received the same treatment of PPH but who had not received plasma at the moment of matching. Transfusions were not guided by coagulation tests. Statistical analysis was performed from June 2018 to June 2019. EXPOSURES Transfusion of plasma during the first 60 minutes of persistent PPH vs no or later plasma transfusion. MAIN OUTCOMES AND MEASURES Incidence of adverse maternal outcomes, defined as a composite of death, hysterectomy, or arterial embolization. RESULTS This study included 1216 women (mean [SD] age, 31.6 [5.0] years) with persistent PPH, of whom 932 (76.6%) delivered vaginally and 780 (64.1%) had PPH caused by uterine atony. Seven women (0.6%) died because of PPH, 62 women (5.1%) had a hysterectomy, and 159 women (13.1%) had arterial embolizations. Among women who received plasma during the first 60 minutes of persistent PPH, 114 women could be matched with a comparable woman who had not received plasma at the moment of matching. The incidence of adverse maternal outcomes was similar between the women, with adverse outcomes recorded in 24 women (21.2%) who received early plasma transfusion and 23 women (19.9%) who did not receive early plasma transfusion (odds ratio, 1.09; 95% CI, 0.57-2.09). Results of sensitivity analyses were comparable to the primary results. CONCLUSIONS AND RELEVANCE In this cohort study, initiation of plasma transfusion during the first 60 minutes of persistent PPH was not associated with adverse maternal outcomes compared with no or later plasma transfusion, independent of severity of PPH.

引用

页数：16

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