학술논문
Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with 'refractoriness to treatment': a cohort study
Document Type
Report
Author
Henriquez, Dacia D. C. A.; Gillissen, Ada; Smith, Sharissa M.; Cramer, Roos A.; van den Akker, Thomas; Zwart, Joost J.; van Roosmalen, Jos J. M.; Bloemenkamp, Kitty W. M.; van der Bom, Johanna G.; Adriaanse, H.J.; van den Akker, E.S.A.; Baas, M.I.; Bank, C.M.C.; van Beek, E.; de Boer, B.A.; de Boer, K.; van der Borden, D.M.R.; Bremer, H.A.; Brons, J.T.J.; Burggraaff, J.M.; Ceelie, H.; Chon, H.; Cikot, J.L.M.; Delemarre, F.M.C.; Diris, J.H.C.; Kleffens, M. Doesburg- Van; van Dooren, I.M.A.; van Duijnhoven, J.L.P.; van Dunné, F.M.; Duvekot, J.J.; Engbers, P.; Hulst, M. J. W. Van Etten-Van; Feitsma, H.; Fouraux, M.A.; Franssen, M.T.M.; Frasa, M.A.M.; van Gammeren, A.J.; van Gemund, N.; van der Graaf, F.; de Groot, C.J.M.; Hackeng, C.M.; van der Ham, D.P.; Hanssen, M.J.C.P.; Hasaart, T.H.M.; Hendriks, H.A.; Henskens, Y.M.C.; Hermsen, B.B.J.; Hogenboom, S.; Hooker, A.; Hudig, F.; Huijssoon, A.M.G.; Huisjes, A.J.M.; Jonker, N.; Kabel, P.J.; van Kampen, C.; de Keijzer, M.H.; van de Kerkhof, D.H.; Keuren, J. F. W.; Kleiverda, G.; Klinkspoor, J.H.; Koehorst, S.G.A.; Kok, M.; Kok, R.D.; de Kok, J.B.; Koops, A.; Kortlandt, W.; Langenveld, J.; Leers, M.P.G.; Leyte, A.; de Mare, A.; Martens, G.D.M.; Meekers, J.H.; van Meir, C.A.; Metz, G.C.H.; Michielse, E.C.H.J.; Mostert, L. J.; Bijvank, S. W. H. Nij; Oostenveld, E.; Osmanovic, N.; Oudijk, M.A.; Pagano Mirani-Oostdijk, C.; van Pampus, E.C.M.; Papatsonis, D.N.M.; Peters, R.H.M.; Ponjee, G.A.E.; Pontesilli, M.; Porath, M.M.; Post, M.S.; Pouwels, J.G.J.; Prinzen, L.; Roelofsen, J.M.T.; Rondeel, J.J.M.; van der Salm, P.C.M.; Scheepers, H.C.J.; Schippers, D.H.; Schuitemaker, N.W.E.; Sikkema, J.M.; Slomp, J.; Smit, J.W.; Lange, Y. S. Snuif-de; van der Stappen, J.W.J.; Steures, P.; Tax, G. H. M.; Treskes, M.; Ulenkate, H.J.L.M.; van Unnik, G.A.; van der Veen, B.S.; Verhagen, T.E.M.; Versendaal, J.; Visschers, B.; Visser, O.; Visser, H.; de Vooght, K.M.K.; de Vries, M.J.; de Waard, H.; Weerkamp, F.; Weinans, M.J.N.; de Wet, H.; van Wijnen, M.; van Wijngaarden, W.J.; de Wit, A.C.; Woiski, M.D.
Source
BMC Pregnancy and Childbirth. October 17, 2019, Vol. 19 Issue 1
Subject
Language
English
Abstract
Author(s): Dacia D. C. A. Henriquez[sup.1,2,3,4] , Ada Gillissen[sup.1,2,3,4] , Sharissa M. Smith[sup.1,2,3,4] , Roos A. Cramer[sup.1,2,3,4] , Thomas van den Akker[sup.1] , Joost J. Zwart[sup.5] , Jos J. M. [...]
Background The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of persistent postpartum haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common definitions that are either based on estimations of blood loss or transfused units of packed red blood cells (RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured by these three types of definitions. Methods In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive women with postpartum haemorrhage who received either [greater than or equai to]4 units of RBC or a multicomponent transfusion. Clinical characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation and intensive care unit admission. Results One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h following birth, compared to 819/1391 (58.7%) applying the definition of [greater than or equai to]1 L blood loss and 37/845 (4.4%) applying the definition of [greater than or equai to]4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal outcomes (91.3%), compared to 471/471 (100%) for [greater than or equai to]1 L blood loss and 383/471 (81.3%) for [greater than or equai to]4 units of RBC. Persistent postpartum haemorrhage did not capture all adverse outcomes because of missing data on timing of initial, first-line treatment. Conclusion The definition persistent postpartum haemorrhage identified women with severe postpartum haemorrhage at an early stage of haemorrhage, unlike definitions based on blood transfusion. It also captured a large majority of adverse maternal outcomes, almost as large as the definition of [greater than or equai to]1 L blood loss, which is commonly applied as a definition of postpartum haemorrhage rather than severe haemorrhage. Keywords: Definition, Maternal morbidity, Maternal mortality, Postpartum haemorrhage
Background The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of persistent postpartum haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common definitions that are either based on estimations of blood loss or transfused units of packed red blood cells (RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured by these three types of definitions. Methods In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive women with postpartum haemorrhage who received either [greater than or equai to]4 units of RBC or a multicomponent transfusion. Clinical characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation and intensive care unit admission. Results One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h following birth, compared to 819/1391 (58.7%) applying the definition of [greater than or equai to]1 L blood loss and 37/845 (4.4%) applying the definition of [greater than or equai to]4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal outcomes (91.3%), compared to 471/471 (100%) for [greater than or equai to]1 L blood loss and 383/471 (81.3%) for [greater than or equai to]4 units of RBC. Persistent postpartum haemorrhage did not capture all adverse outcomes because of missing data on timing of initial, first-line treatment. Conclusion The definition persistent postpartum haemorrhage identified women with severe postpartum haemorrhage at an early stage of haemorrhage, unlike definitions based on blood transfusion. It also captured a large majority of adverse maternal outcomes, almost as large as the definition of [greater than or equai to]1 L blood loss, which is commonly applied as a definition of postpartum haemorrhage rather than severe haemorrhage. Keywords: Definition, Maternal morbidity, Maternal mortality, Postpartum haemorrhage