Stephen J McCall1,2, Dacia Henriquez3,4, Hellen McKinnon Edwards5, Thomas van den Akker1,3, Kitty W M Bloemenkamp6, Johanna van der Bom4, Marie-Pierre Bonnet7,8, Catherine Deneux-Tharaux8, Serena Donati9, Ada Gillissen3,4, Jennifer J Kurinczuk1, Zhuoyang Li10, Alice Maraschini9, Aurélien Seco7,11, Elizabeth Sullivan10, Simon Stanworth12,13,14, Marian Knight1. 1. National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, United Kingdom. 2. Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon. 3. Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands. 4. Jon J van Rood Center for Clinical Transfusion Research, Sanquin Research & Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands. 5. Department of Obstetrics and Gynaecology, Copenhagen University Hospital Herlev, Herlev, Denmark. 6. Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, Netherlands. 7. Department of Anaesthesiology and Critical Care, Armand Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France. 8. INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and Biostatistics (CRESS), Paris University, Paris, France. 9. National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy. 10. Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia. 11. Clinical Research Unit of Paris Descartes Necker Cochin, APHP, Paris, France. 12. Oxford University Hospitals NHS Trust, Department of Haematology, Oxford, United Kingdom. 13. NIHR BRC Blood Theme, University of Oxford, Oxford, United Kingdom. 14. NHS Blood and Transplant, John Radcliffe Hospital, Oxford, United Kingdom.
Abstract
BACKGROUND: 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. METHODS: 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. FINDINGS: 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%. INTERPRETATION: 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.
BACKGROUND: 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. METHODS: 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. FINDINGS: 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%. INTERPRETATION: 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.
Authors: Jillian A Patterson; Christine L Roberts; Jennifer R Bowen; David O Irving; James P Isbister; Jonathan M Morris; Jane B Ford Journal: Obstet Gynecol Date: 2014-01 Impact factor: 7.661
Authors: Jeannie Callum; Michael E Farkouh; Damon C Scales; Nancy M Heddle; Mark Crowther; Vivek Rao; Hans-Peter Hucke; Jo Carroll; Deep Grewal; Sukhpal Brar; Jean Bussières; Hilary Grocott; Christopher Harle; Katerina Pavenski; Antoine Rochon; Tarit Saha; Lois Shepherd; Summer Syed; Diem Tran; Daniel Wong; Michelle Zeller; Keyvan Karkouti Journal: JAMA Date: 2019-11-26 Impact factor: 56.272