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1. Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with ‘refractoriness to treatment’: a cohort study

Author

Henriquez, D.D.C.A., Gillissen, A., Smith, S.M., Cramer, R.A., Akker, T. van den, Zwart, J.J., Roosmalen, J.J.M. van, Bloemenkamp, K.W.M., Bom, J.G. van der, Adriaanse, H.J., Akker, E.S.A. van den, Baas, M.I., Bank, C.M.C., Beek, E. van, Boer, B.A. de, Boer, K. de, Borden, D.M.R. van der, Bremer, H.A., Brons, J.T.J., Burggraaff, J.M., Ceelie, H., Chon, H., Cikot, J.L.M., Delemarre, F.M.C., Diris, J.H.C., Doesburg-van Kleffens, M., Dooren, I.M.A. van, Duijnhoven, J.L.P. van, Dunn, F.M. van, Duvekot, J.J., Engbers, P., Etten-van Hulst, M.J.W. van, Feitsma, H., Fouraux, M.A., Franssen, M.T.M., Frasa, M.A.M., Gammeren, A.J. van, Gemund, N. van, Graaf, F. van der, Groot, C.J.M. de, Hackeng, C.M., Ham, D.P. van der, Hanssen, M.J.C.P., Hasaart, T.H.M., Hendriks, H.A., Henskens, Y.M.C., Hermsen, B.B.J., Hogenboom, S., Hooker, A., Hudig, F., Huijssoon, A.M.G., Huisjes, A.J.M., Jonker, N., Kabel, P.J., Kampen, C. van, Keijzer, M.H. de, Kerkhof, D.H. van de, Keuren, J.F.W., Kleiverda, G., Klinkspoor, J.H., Koehorst, S.G.A., Kok, M., Kok, R.D., Kok, J.B. de, Koops, A., Kortlandt, W., Langenveld, J., Leers, M.P.G., Leyte, A., Mare, A. de, Martens, G.D.M., Meekers, J.H., Meir, C.A. van, Metz, G.C.H., Michielse, E.C.H.J., Mostert, L.J., Bijvank, S.W.H.N., Oostenveld, E., Osmanovic, N., Oudijk, M.A., Mirani-Oostdijk, C.P., Pampus, E.C.M. van, Papatsonis, D.N.M., Peters, R.H.M., Ponjee, G.A.E., Pontesilli, M., Porath, M.M., Post, M.S., Pouwels, J.G.J., Prinzen, L., Roelofsen, J.M.T., Rondeel, J.J.M., Salm, P.C.M. van der, Scheepers, H.C.J., Schippers, D.H., Schuitemaker, N.W.E., Sikkema, J.M., Slomp, J., Smit, J.W., Snuif-de Lange, Y.S., Stappen, J.W.J. van der, Steures, P., Tax, G.H.M., Treskes, M., Ulenkate, H.J.L.M., Unnik, G.A. van, Veen, B.S. van der, Verhagen, T.E.M., Versendaal, J., Visschers, B., Visser, O., Visser, H., Vooght, K.M.K. de, Vries, M.J. de, Waard, H. de, Weerkamp, F., Weinans, M.J.N., Wet, H. de, Wijnen, M. van, Wijngaarden, W.J. van, Wit, A.C. de, Woiski, M.D., TeMpOH-1 Study Grp, Obstetrics & Gynecology, Science Communication, APH - Global Health, Athena Institute, APH - Quality of Care, Reproductive Origins of Adult Health and Disease (ROAHD), Ethics, Law & Medical humanities, Cardiology, ACS - Heart failure & arrhythmias, Obstetrics and gynaecology, Amsterdam Reproduction & Development (AR&D), Pediatric surgery, Hematology, Faculteit FHML Centraal, RS: CARIM - R1.04 - Clinical thrombosis and haemostasis, MUMC+: DA CDL Algemeen (9), RS: GROW - R4 - Reproductive and Perinatal Medicine, MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), Obstetrie & Gynaecologie, and RS: Carim - B04 Clinical thrombosis and Haemostasis more...

Subjects
Male, Blood transfusion, Refractory period, medicine.medical_treatment, 030204 cardiovascular system & hematology, Severity of Illness Index, law.invention, Postpartum haemorrhage, 0302 clinical medicine, law, Pregnancy, Risk Factors, Netherlands, 030219 obstetrics & reproductive medicine, Obstetrics, Incidence, Obstetrics and Gynecology, Prognosis, Intensive care unit, Embolization, Therapeutic, PREVALENCE, Survival Rate, Female, Cohort study, Research Article, Maternal mortality, Adult, medicine.medical_specialty, Reproductive medicine, Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0], Hysterectomy, lcsh:Gynecology and obstetrics, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, SDG 3 - Good Health and Well-being, medicine, Humans, Blood Transfusion, lcsh:RG1-991, Retrospective Studies, SEVERE MATERNAL MORBIDITY, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Postpartum Hemorrhage, Infant, Newborn, Retrospective cohort study, Definition, Packed red blood cells, business, Maternal morbidity, Follow-Up Studies
Abstract

Background The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of persistent postpartum haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common definitions that are either based on estimations of blood loss or transfused units of packed red blood cells (RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured by these three types of definitions. Methods In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive women with postpartum haemorrhage who received either ≥4 units of RBC or a multicomponent transfusion. Clinical characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation and intensive care unit admission. Results One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h following birth, compared to 819/1391 (58.7%) applying the definition of ≥1 L blood loss and 37/845 (4.4%) applying the definition of ≥4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal outcomes (91.3%), compared to 471/471 (100%) for ≥1 L blood loss and 383/471 (81.3%) for ≥4 units of RBC. Persistent postpartum haemorrhage did not capture all adverse outcomes because of missing data on timing of initial, first-line treatment. Conclusion The definition persistent postpartum haemorrhage identified women with severe postpartum haemorrhage at an early stage of haemorrhage, unlike definitions based on blood transfusion. It also captured a large majority of adverse maternal outcomes, almost as large as the definition of ≥1 L blood loss, which is commonly applied as a definition of postpartum haemorrhage rather than severe haemorrhage. more...

Published
2019
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2. Fluid resuscitation during persistent postpartum haemorrhage and maternal outcome: A nationwide cohort study

Author

Henriquez, D.D.C.A., Bloemenkamp, K.W.M., Loeff, R.M., Zwart, J.J., Roosmalen, J.J.M. van, Zwaginga, J.J., Bom, J.G. van der, Adriaanse, H.J., Akker, E.S.A. van den, Baas, M.I., Bank, C.M.C., Beek, E. van, Boer, B.A. de, Boer, K. de, Borden, D.M.R. van der, Bremer, H.A., Brons, J.T.J., Burggraaff, J.M., Ceelie, H., Chon, H., Cikot, J.L.M., Delemarre, F.M.C., Diris, J.H.C., Doesburg-van Kleffens, M., Dooren, I.M.A. van, Duijnhoven, J.L.P. van, Dunne, F.M. van, Duvekot, J.J., Engbers, P., Hulst, M.J.W.V., Feitsma, H., Fouraux, M.A., Franssen, M.T.M., Frasa, M.A.M., Gammeren, A.J. van, Gemund, N. van, Graaf, F. van der, Groot, C.J.M. de, Hackeng, C.M., Ham, D.P. van der, Hanssen, M.J.C.P., Hasaart, T.H.M., Hendriks, H.A., Henskens, Y.M.C., Hermsen, B.B.J., Hogenboom, S., Hooker, A., Hudig, F., Huijssoon, A.M.G., Huisjes, A.J.M., Jonker, N., Kabel, P.J., Kampen, C. van, Keijzer, M.H. de, Kerkhof, D.H. van de, Keuren, J.F.W., Kleiverda, G., Klinkspoor, J.H., Koehorst, S.G.A., Kok, M., Kok, R.D., Kok, J.B. de, Koops, A., Kortlandt, W., Langenveld, J., Leers, M.P.G., Leyte, A., Mare, A. de, Martens, G.D.M., Meekers, J.H., Meir, C.A. van, Metz, G.C.H., Michielse, E.C.H.J., Mostert, L.J., Bijvank, S.W.H.N., Oostenveld, E., Osmanovic, N., Oudijk, M.A., Mirani-Oostdijk, C.P., Pampus, E.C.M. van, Papatsonis, D.N.M., Peters, R.H.M., Ponjee, G.A.E., Pontesilli, M., Porath, M.M., Post, M.S., Pouwels, J.G.J., Prinzen, L., Roelofsen, J.M.T., Rondeel, J.J.M., Salm, P.C.M. van der, Scheepers, H.C.J., Schippers, D.H., Schuitemaker, N.W.E., Sikkema, J.M., Slomp, J., Smit, J.W., Snuif-de Lange, Y.S., Stappen, J.W.J. van der, Steures, P., Tax, G.H.M., Treskes, M., Ulenkate, H.J.L.M., Unnik, G.A. van, Veen, B.S. van der, Verhagen, T.E.M., Versendaal, J., Visschers, B., Visser, O., Visser, H., Vooght, K.M.K. de, Vries, M.J. de, Waard, H. de, Weerkamp, F., Weinans, M.J.N., Wet, H. de, Wijnen, M. van, Wijngaarden, W.J. van, Wit, A.C. de, Woiski, M.D., TeMpOH-Study Grp, APH - Quality of Care, APH - Global Health, Obstetrics & Gynecology, RS: CARIM - R1.04 - Clinical thrombosis and haemostasis, MUMC+: DA CDL Algemeen (9), Faculteit FHML Centraal, RS: Carim - B04 Clinical thrombosis and Haemostasis, Reproductive Origins of Adult Health and Disease (ROAHD), and Athena Institute more...

Subjects
Adult, medicine.medical_specialty, Resuscitation, Blood transfusion, medicine.medical_treatment, CRYSTALLOIDS, Postpartum haemorrhage, 03 medical and health sciences, RED-BLOOD-CELLS, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Interquartile range, Pregnancy, ERYTHROCYTES, medicine, Humans, Crystalloid solutions, 030212 general & internal medicine, Colloids, THROMBIN GENERATION, Netherlands, Retrospective Studies, COAGULOPATHY, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, Postpartum Hemorrhage, Obstetrics and Gynecology, Retrospective cohort study, Odds ratio, Confidence interval, Treatment Outcome, Reproductive Medicine, Fluid Therapy, TRAUMA PATIENTS, Female, Packed red blood cells, business, Cohort study
Abstract

Objective: To determine the association between increasing volumes of crystalloids and colloids administered before transfusion of packed red blood cells in women with persistent postpartum haemorrhage and adverse maternal outcomes. Study design: Retrospective cohort study in the Netherlands. Women with persistent postpartum haemorrhage and known clear fluids volume for resuscitation were included. Women who received ≤2 L of clear fluids were the reference group. We determined the effect of every additional litre of clear fluids on total blood loss, severe maternal morbidity and mortality. Results were adjusted for patient and bleeding characteristics. Results: Of the 883 included women, 199 received ≤2 L of clear fluids. Median blood loss for the reference group was 2.9 L (interquartile range 2.2–3.4). Adjusted mean difference in blood loss compared with the reference group was 0.2 L (95% confidence interval −0.1 to 0.5) for women in the >2 to ≤3 L, 0.4 L (0.1–0.7) for the >3 to ≤4 L category, 0.6 L (0.5–0.7) for the >4 to ≤5 L category, and 1.9 L (1.5–2.3) for the >5 to ≤7 L category. Adjusted odds ratios for adverse maternal outcomes were 1.0 (0.7–1.6), 1.2 (0.8–1.9), 1.8 (1.1–3.1) and 4.4 (2.6–7.5) for women in the 2 to ≤3 L category, >3 to ≤4 L, >4 to ≤5 L, and >5 to ≤7 L volume categories respectively. Results were similar in strata of different severities of bleeding. Conclusion: Clear fluids volume >4 L was independently associated with adverse maternal outcome in women with persistent postpartum haemorrhage. more...

Published
2019
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3. Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with 'refractoriness to treatment': a cohort study

Author

Henriquez, D., Gillissen, A., Smith, S.M., Cramer, R.A., van den Akker, T., Zwart, J.J. (Joost), van Roosmalen, J.J., Bloemenkamp, KW, Bom, J.G., Adriaanse, H.J., van den Akker, E.S.A., Baas, M.I., Bank, C.M.C., Beek, E. van, de Boer, B.A.G., Boer, K. (Karin), van der Borden, D.M.R., Bremer, H.A. (Henk), Brons, J.T.J., Burggraaff, J.M. (Jan), Ceelie, H., Chon, H., Cikot, J.L.M., Delemarre, F.M.C., Diris, J.H.C., Doesburg-van Kleffens, M., van Dooren, I.M.A., van Duijnhoven, J.L.P., van Dunn, F.M., Duvekot, J.J. (Hans), Engbers, P., van Hulst, M.J.W., Feitsma, H., Fouraux, M.A., Franssen, MT, Frasa, M.A.M., van Gammeren, A.J., Gemund, N. (Nicolette) van, van der Graaf, F., Groot, C.J.M., Hackeng, C.M. (Christian), Ham, D.P. (David) van der, Hanssen, M., Hasaart, T.H.M. (Tom), Hendriks, H.A., Henskens, Y.M.C., Hermsen, B.B.J., Hogenboom, S., Hooker, A., Hudig, F, Huijssoon, A.G. (Annemarie), Huisjes, A.J.M. (Anjoke), Jonker, N., Kabel, P.J., van Kampen, C., de Keijzer, M.H., van de Kerkhof, D.H., Keuren, JFW, Kleiverda, G., Klinkspoor, J.H., Koehorst, S.G.A., Kok, M.O. (Maarten), Kok, R.D., Kok, J.B. (Jacques) de, Koops, A., Kortlandt, W. (Wouter), Langenveld, J. (J.), Leers, MPG, Leyte, A. (Anja), de Mare, A., Martens, G.D.M., Meekers, J.H., Meir, C.A. (Claudia) van, Metz, G.C.H. (Godfried), Michielse, E., Mostert, L.J., Bijvank, S., Oostenveld, E., Osmanovic, N., Oudijk, M.A. (Martijn), Mirani-Oostdijk, C.P., van Pampus, E. C. M., Papatsonis, D.N.M. (Dimitri), Peters, R.H.M., Ponjee, G.A.E. (Gabriëlle), Pontesilli, M., Porath, M. (Martina), Post, M.S., Pouwels, J.G.J., Prinzen, L., Roelofsen, J.M.T., Rondeel, J.J.M., Salm, P.C.M. (Paulien) van der, Scheepers, H.C.J. (Hubertina), Schippers, D.H. (Daniela), Schuitemaker, N.W.E. (Nico), Sikkema, J.M. (J. Marko), Slomp, J. (Jennita), Smit, J.W.A. (Jan), Snuif-de Lange, Y.S., van der Stappen, J.W.J., Steures, P. (Pieternel), Tax, G.H.M., Treskes, M., Ulenkate, H., van Unnik, G.A., van der Veen, B.S., Verhagen, T.E.M., Versendaal, J. (Johan), Visschers, B., Visser, O. (Oane), de Visser, H., De Vooght, KMK, de Vries, M.J., Waard, H. (Harm) de, Weerkamp, F. (Floor), Weinans, M.J.N. (Martin), de Wet, H., Wijnen, M. (Marit), Wijngaarden, W.J. (Wim) van, de Wit, A.C., Woiski, M.D. (Mallory), TeMp, O.H.S.G., Henriquez, D., Gillissen, A., Smith, S.M., Cramer, R.A., van den Akker, T., Zwart, J.J. (Joost), van Roosmalen, J.J., Bloemenkamp, KW, Bom, J.G., Adriaanse, H.J., van den Akker, E.S.A., Baas, M.I., Bank, C.M.C., Beek, E. van, de Boer, B.A.G., Boer, K. (Karin), van der Borden, D.M.R., Bremer, H.A. (Henk), Brons, J.T.J., Burggraaff, J.M. (Jan), Ceelie, H., Chon, H., Cikot, J.L.M., Delemarre, F.M.C., Diris, J.H.C., Doesburg-van Kleffens, M., van Dooren, I.M.A., van Duijnhoven, J.L.P., van Dunn, F.M., Duvekot, J.J. (Hans), Engbers, P., van Hulst, M.J.W., Feitsma, H., Fouraux, M.A., Franssen, MT, Frasa, M.A.M., van Gammeren, A.J., Gemund, N. (Nicolette) van, van der Graaf, F., Groot, C.J.M., Hackeng, C.M. (Christian), Ham, D.P. (David) van der, Hanssen, M., Hasaart, T.H.M. (Tom), Hendriks, H.A., Henskens, Y.M.C., Hermsen, B.B.J., Hogenboom, S., Hooker, A., Hudig, F, Huijssoon, A.G. (Annemarie), Huisjes, A.J.M. (Anjoke), Jonker, N., Kabel, P.J., van Kampen, C., de Keijzer, M.H., van de Kerkhof, D.H., Keuren, JFW, Kleiverda, G., Klinkspoor, J.H., Koehorst, S.G.A., Kok, M.O. (Maarten), Kok, R.D., Kok, J.B. (Jacques) de, Koops, A., Kortlandt, W. (Wouter), Langenveld, J. (J.), Leers, MPG, Leyte, A. (Anja), de Mare, A., Martens, G.D.M., Meekers, J.H., Meir, C.A. (Claudia) van, Metz, G.C.H. (Godfried), Michielse, E., Mostert, L.J., Bijvank, S., Oostenveld, E., Osmanovic, N., Oudijk, M.A. (Martijn), Mirani-Oostdijk, C.P., van Pampus, E. C. M., Papatsonis, D.N.M. (Dimitri), Peters, R.H.M., Ponjee, G.A.E. (Gabriëlle), Pontesilli, M., Porath, M. (Martina), Post, M.S., Pouwels, J.G.J., Prinzen, L., Roelofsen, J.M.T., Rondeel, J.J.M., Salm, P.C.M. (Paulien) van der, Scheepers, H.C.J. (Hubertina), Schippers, D.H. (Daniela), Schuitemaker, N.W.E. (Nico), Sikkema, J.M. (J. Marko), Slomp, J. (Jennita), Smit, J.W.A. (Jan), Snuif-de Lange, Y.S., van der Stappen, J.W.J., Steures, P. (Pieternel), Tax, G.H.M., Treskes, M., Ulenkate, H., van Unnik, G.A., van der Veen, B.S., Verhagen, T.E.M., Versendaal, J. (Johan), Visschers, B., Visser, O. (Oane), de Visser, H., De Vooght, KMK, de Vries, M.J., Waard, H. (Harm) de, Weerkamp, F. (Floor), Weinans, M.J.N. (Martin), de Wet, H., Wijnen, M. (Marit), Wijngaarden, W.J. (Wim) van, de Wit, A.C., Woiski, M.D. (Mallory), and TeMp, O.H.S.G. more...

Abstract

Background: The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of persistent postpartum haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common definitions that are either based on estimations of blood loss or transfused units of packed red blood cells (RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured by these three types of definitions. Methods: In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive women with postpartum haemorrhage who received either ≥4 units of RBC or a multicomponent transfusion. Clinical characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation and intensive care unit admission. Results: One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h following birth, compared to 819/1391 (58.7%) applying the definition of ≥1 L blood loss and 37/845 (4.4%) applying the definition of ≥4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal outcomes (91.3%), compared to 471/471 (100%) for ≥1 L blood loss and 383/471 (81.3%) for ≥4 units of RBC. Persiste more...

Published
2019
Full Text
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