A total blood volume or more transfused during pregnancy or after childbirth: Individual patient data from six international population-based observational studies

This study aimed to compare incidence, management and outcomes of women transfused their blood volume or more within 24 hours during pregnancy or following childbirth. Combined analysis of individual patient data, prospectively collected in six international population-based studies (France, United...

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Bibliographic Details
Published in:PloS one 2021-01, Vol.16 (1), p.e0244933-e0244933
Main Authors: McCall, Stephen J, Henriquez, Dacia, Edwards, Hellen McKinnon, van den Akker, Thomas, Bloemenkamp, Kitty W M, van der Bom, Johanna, Bonnet, Marie-Pierre, Deneux-Tharaux, Catherine, Donati, Serena, Gillissen, Ada, Kurinczuk, Jennifer J, Li, Zhuoyang, Maraschini, Alice, Seco, Aurélien, Sullivan, Elizabeth, Stanworth, Simon, Knight, Marian
Format: Article
Language:English
Subjects:
Adult
Anesthesiology
Biology and Life Sciences
Births
Blood
Blood cells
Blood transfusion
Blood Transfusion - statistics & numerical data
Blood volume
Care and treatment
Childbirth & labor
Critical care
Data Collection
Delivery, Obstetric - statistics & numerical data
Disease prevention
Editing
Epidemiology
Erythrocytes
Female
Funding
Gestation
Gynecology
Health care facilities
Health promotion
Hematology
Hemorrhage
Hospitals
Humans
Intensive care
Internationality
Maternal mortality
Medical records
Medical research
Medicine
Medicine and Health Sciences
Methodology
Morbidity
Mothers
Observational studies
Observational Studies as Topic
Obstetrics
Patient outcomes
Pediatrics
People and places
Population
Population studies
Population-based studies
Postpartum
Pregnancy
Pregnant women
Prevention
Research facilities
Statistics
Surveillance
Transfusion
Womens health
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Description
Summary:This study aimed to compare incidence, management and outcomes of women transfused their blood volume or more within 24 hours during pregnancy or following childbirth. Combined analysis of individual patient data, prospectively collected in six international population-based studies (France, United Kingdom, Italy, Australia, the Netherlands and Denmark). Massive transfusion in major obstetric haemorrhage was defined as transfusion of eight or more units of red blood cells within 24 hours in a pregnant or postpartum woman. Causes, management and outcomes of women with massive transfusion were compared across countries using descriptive statistics. The incidence of massive transfusion was approximately 21 women per 100,000 maternities for the United Kingdom, Australia and Italy; by contrast Denmark, the Netherlands and France had incidences of 82, 66 and 69 per 100,000 maternities, respectively. There was large variation in obstetric and haematological management across countries. Fibrinogen products were used in 86% of women in Australia, while the Netherlands and Italy reported lower use at 35-37% of women. Tranexamic acid was used in 75% of women in the Netherlands, but in less than half of women in the UK, Australia and Italy. In all countries, women received large quantities of colloid/crystalloid fluids during resuscitation (>3·5 litres). There was large variation in the use of compression sutures, embolisation and hysterectomy across countries. There was no difference in maternal mortality; however, variable proportions of women had cardiac arrests, renal failure and thrombotic events from 0-16%. There was considerable variation in the incidence of massive transfusion associated with major obstetric haemorrhage across six high-income countries. There were also large disparities in both transfusion and obstetric management between these countries. There is a requirement for detailed evaluation of evidence underlying current guidance. Furthermore, cross-country comparison may empower countries to reference their clinical care against that of other countries.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0244933