1. Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with ‘refractoriness to treatment’: a cohort study
- Author
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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...
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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...
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- 2019
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