Hiroaki Tanaka1, Shinji Katsuragi2, Kazuhiro Osato1, Junichi Hasegawa3, Masahiko Nakata4, Takeshi Murakoshi5, Jun Yoshimatsu6, Akihiko Sekizawa3, Naohiro Kanayama7, Isamu Ishiwata8, Tomoaki Ikeda1. 1. Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan. 2. Department of Obstetrics and Gynecology, Sakakibara Heart Institute. 3. Department of Obstetrics and Gynecology, Showa University School of Medicine. 4. Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan. 5. Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan. 6. Division of Maternal Fetal Medicine and Gynecology, National Cerebral and Cardiovascular Center, Osaka, Japan. 7. Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Shizuoka, Japan. 8. Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan.
Abstract
BACKGROUND: 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. STUDY DESIGN AND METHODS: 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. RESULTS: 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. CONCLUSION: Transfusion with FFP:RBC ratio of 1 or more is associated with higher survival rate in women with AFE with coagulopathy.
BACKGROUND: 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. STUDY DESIGN AND METHODS: 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. RESULTS: 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. CONCLUSION: Transfusion with FFP:RBC ratio of 1 or more is associated with higher survival rate in women with AFE with coagulopathy.
Authors: Kathryn E Fitzpatrick; Thomas van den Akker; Kitty W M Bloemenkamp; Catherine Deneux-Tharaux; Alexandra Kristufkova; Zhuoyang Li; Timme P Schaap; Elizabeth A Sullivan; Derek Tuffnell; Marian Knight Journal: PLoS Med Date: 2019-11-12 Impact factor: 11.069