Abstract Number: PB2536
Meeting: ISTH 2020 Congress
Background: In a recent study initiation of plasma transfusion during the first 60 minutes of persistent postpartum haemorrhage was not associated with more favourable maternal outcomes. Some argued that this absence of effect may have been due to too high volumes of resuscitation fluids. The RCOG guideline recommends to infuse less than3.5L of fluids before blood transfusion.
Aims: To quantify the association of plasma transfusion within 60 minutes after diagnosing persistent PPH and adverse maternal outcome among women who received less than 3.5L of resuscitation fluids, and similarly among women who received more than 3.5L.
Methods: We performed a secondary analysis in a retrospective cohort of women with persistent PPH. Women were enrolled between 2011 and 2013 in 61 hospitals. The outcome was a composite of maternal mortality, hysterectomy and arterial embolization. In a time-dependent propensity score-matched analysis, women with transfusion of plasma early, i.e. within 60 minutes following PPH diagnosis, were matched to women without early plasma transfusion; with sensitivity analyses of plasma within 120 and 180 minutes.
Results: The cohort consisted of 1216 women with persistent PPH; seven women died (0.6%), 62 underwent hysterectomy (5.1%) and 159 arterial embolization (13.1%). Among women who had received less than 3.5L fluids there was no difference in outcome between those who had received plasma early and those who had received plasma later, adjusted odds ratio 1.02 (95% confidence interval 0.44 to 2.40, 77 pairs); among women who had received more than 3.5L the odds ratio was 0.78 (0.25 to 2.38, 34 pairs).
Conclusions: These findings do not support the notion that the previously observed absence of association between early plasma transfusion and maternal outcome was due to too high volumes of resuscitation fluids. Whether early plasma transfusion prevents adverse maternal outcomes when the volume of resuscitation fluids is much lower than 3.5L remains to be established.
To cite this abstract in AMA style:Caram-Deelder C, Henriquez D, le Cessie S, Zwart J, van Roosmalen J, Eikenboom H, So-Osman C, van de Watering L, Zwaginga JJ, Koopman-van Gemert A, Bloemenkamp K, van der Bom JG, TeMpOH-1 . Early Plasma Transfusion and Maternal Outcomes in Women with Persistent Postpartum Haemorrhage: Does the Amount of Resuscitation Fluids Matter? [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/early-plasma-transfusion-and-maternal-outcomes-in-women-with-persistent-postpartum-haemorrhage-does-the-amount-of-resuscitation-fluids-matter/. Accessed March 3, 2021.
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