INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Port Royal Maternity Unit, Cochin Teaching Hospital, Paris, France.
Acta Obstet Gynecol Scand. 2013 Apr;92(4):404-13. doi: 10.1111/aogs.12063. Epub 2013 Jan 16.
To describe transfusion practices and anemia in women with postpartum hemorrhage (PPH), according to the clinical context.
Population-based cohort study.
A total of 106 French maternity units (146 781 deliveries, December 2004 to November 2006).
All women with PPH (n = 9365).
Description of the rate of red blood cell (RBC) transfusion in PPH overall and compared with transfusion guidelines.
Transfusion practices and postpartum anemia by mode of delivery and cause of PPH in women given RBCs within 12 h after PPH.
A total of 701 women received RBCs (0.48 ± 0.04% of all women and 7.5 ± 0.5% of women with PPH). Half the women with clinical PPH and hemoglobin lower than 7.0 g/dL received no RBCs. In the group with clinical PPH and transfusion within 12 h (n = 426), operative vaginal delivery was associated with a larger maximal hemoglobin drop, more frequent administration of fresh-frozen plasma (FFP) and pro-hemostatic agents [odds ratio (OR) 3.54, 95% confidence interval (95% CI) 1.12-11.18], transfusion of larger volumes of RBCs and FFP, a higher rate of massive RBCs transfusion (OR 5.22, 95% CI 2.12-12.82), and more frequent use of conservative surgery (OR 3.2, 95% CI 1.34-7.76), compared with spontaneous vaginal delivery.
The RBC transfusion for PPH was not given in a large proportion of women with very low hemoglobin levels despite guidelines to the contrary. Operative vaginal delivery is characterized by higher blood loss and more transfusions than spontaneous vaginal delivery.
根据临床情况描述产后出血（PPH）女性的输血实践和贫血情况。
基于人群的队列研究。
共 106 家法国产科单位（2004 年 12 月至 2006 年 11 月共 146781 例分娩）。
所有产后出血（PPH）女性（n=9365）。
描述 PPH 患者的红细胞（RBC）输注率，并与输血指南进行比较。
在产后出血后 12 小时内给予 RBC 的患者，按分娩方式和 PPH 病因分类的输血实践和产后贫血情况。
共有 701 名妇女接受了 RBC 输血（占所有妇女的 0.48±0.04%，PPH 妇女的 7.5±0.5%）。一半血红蛋白水平低于 7.0 g/dL 的有临床 PPH 的妇女没有接受 RBC 输血。在有临床 PPH 且在 12 小时内输血的患者中（n=426），与自然分娩相比，阴道助产分娩与更大的最大血红蛋白下降、更频繁地使用新鲜冷冻血浆（FFP）和促凝剂[比值比（OR）3.54，95%置信区间（95%CI）1.12-11.18]、输注更大体积的 RBC 和 FFP、更高的大量 RBC 输血率（OR 5.22，95%CI 2.12-12.82）以及更频繁地使用保守性手术（OR 3.2，95%CI 1.34-7.76）相关。
尽管有指南相反，但仍有很大比例的血红蛋白水平非常低的 PPH 妇女未接受 RBC 输血。阴道助产分娩的失血量和输血量均高于自然分娩。
