National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, United Kingdom.
Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon.
PLoS One. 2021 Jan 22;16(1):e0244933. doi: 10.1371/journal.pone.0244933. eCollection 2021.
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.
本研究旨在比较在怀孕期间或分娩后 24 小时内输血量或更多的女性的发病率、处理方法和结局。
对 6 项国际基于人群的研究（法国、英国、意大利、澳大利亚、荷兰和丹麦）中前瞻性收集的个体患者数据进行合并分析。在孕妇或产后妇女中，24 小时内输注 8 个或更多单位红细胞即为大量输血。使用描述性统计方法比较各国大量输血女性的病因、处理方法和结局。
英国、澳大利亚和意大利的大量输血发生率约为每 10 万例分娩 21 例；相比之下，丹麦、荷兰和法国的发生率分别为每 10 万例分娩 82 例、66 例和 69 例。各国的产科和血液学处理方法存在较大差异。澳大利亚有 86%的女性使用纤维蛋白原制品，而荷兰和意大利报告的使用率为 35-37%的女性。荷兰有 75%的女性使用氨甲环酸，而英国、澳大利亚和意大利的女性不到一半。在所有国家中，女性在复苏期间接受大量胶体/晶体液（>3.5 升）。各国在使用压缩缝合、栓塞和子宫切除术方面存在较大差异。产妇死亡率无差异；然而，从 0-16%的女性出现心脏骤停、肾衰竭和血栓形成事件的比例不同。
在六个高收入国家中，与严重产科出血相关的大量输血发生率存在相当大的差异。这些国家之间的输血和产科管理也存在很大差异。需要详细评估当前指南所依据的证据。此外，跨国比较可以使各国将其临床护理与其他国家进行比较。
