Tanaka Hiroaki, Katsuragi Shinji, Osato Kazuhiro, Hasegawa Junichi, Nakata Masahiko, Murakoshi Takeshi, Yoshimatsu Jun, Sekizawa Akihiko, Kanayama Naohiro, Ishiwata Isamu, Ikeda Tomoaki
Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan.
Department of Obstetrics and Gynecology, Sakakibara Heart Institute.
Transfusion. 2016 Dec;56(12):3042-3046. doi: 10.1111/trf.13856. Epub 2016 Nov 2.
The Japan Association of Obstetricians and Gynecologists (JAOG) recommends transfusion with a fresh-frozen plasma (FFP):red blood cell (RBC) ratio of 1 or more in postpartum hemorrhage. However, no global consensus exists concerning this, and little is known regarding the impact of FFP:RBC ratio on maternal mortality. This study evaluates the efficacy of transfusion with FFP:RBC ratio of 1 or more for amniotic fluid embolism (AFE) with coagulopathy.
The Maternal Death Exploratory Committee, established by the JAOG, conducted this retrospective nationwide case-control study in Japan. Women with AFE and coagulopathy were included in the study and were stratified into survival and death groups. Obstetric variables and therapy methods (hysterectomy, uterine artery embolism, and transfusion with FFP:RBC ratio ≥ 1) were compared between the survival and death groups.
A total of 54 women had AFE and coagulopathy (death group, n = 22; survival group, n = 32). Only nine (40.9%) women in the death group were transfused with FFP:RBC ratio of 1 or more, whereas 29 (90.6%) women in the survival group were transfused with FFP:RBC ratio of 1 or more. FFP:RBC ratio of 1 or more was found to be associated with better survival rate (adjusted odds ratio, 28.32; 95% confidence interval, 4.26-188.37). No difference was found in obstetric variables, hysterectomy, and uterine artery embolism between survival and death groups.
Transfusion with FFP:RBC ratio of 1 or more is associated with higher survival rate in women with AFE with coagulopathy.
日本妇产科医师协会（JAOG）建议在产后出血时采用新鲜冰冻血浆（FFP）与红细胞（RBC）的输注比例为1或更高。然而，对此尚无全球共识，关于FFP:RBC比例对孕产妇死亡率的影响也知之甚少。本研究评估FFP:RBC比例为1或更高的输血对伴有凝血病的羊水栓塞（AFE）的疗效。
由JAOG设立的孕产妇死亡探索委员会在日本开展了这项全国性回顾性病例对照研究。伴有AFE和凝血病的女性被纳入研究，并分为生存组和死亡组。比较了生存组和死亡组之间的产科变量和治疗方法（子宫切除术、子宫动脉栓塞以及FFP:RBC比例≥1的输血）。
共有54名女性患有AFE和凝血病（死亡组，n = 22；生存组，n = 32）。死亡组中只有9名（40.9%）女性接受了FFP:RBC比例为1或更高的输血，而生存组中有29名（90.6%）女性接受了FFP:RBC比例为1或更高的输血。发现FFP:RBC比例为1或更高与更好的生存率相关（调整后的优势比为28.32；95%置信区间为4.26 - 188.37）。生存组和死亡组在产科变量、子宫切除术和子宫动脉栓塞方面未发现差异。
FFP:RBC比例为1或更高的输血与伴有凝血病的AFE女性的较高生存率相关。
