• Int J Obstet Anesth · May 2020

    Multicenter Study

    A population-based analysis of French transfusion practices for women experiencing severe postpartum hemorrhage.

    • F Deleu, C Deneux-Tharaux, C Chiesa-Dubruille, A Seco, M P Bonnet, and EPIMOMS study group (see Appendix).
    • Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, INSERM UMR 1153, Paris Descartes University, France; Department of Anesthesia, Louis Mourier University Hospital, AP-HP, Paris Diderot University, France.
    • Int J Obstet Anesth. 2020 May 1; 42: 11-19.

    BackgroundTransfusion is a major therapy for severe postpartum hemorrhage but there are few population-based descriptions of practice. The objective of this retrospective French population-based study was to describe transfusion practices in women with severe postpartum hemorrhage and the compliance with guidelines.MethodsStudy data were sourced from a prior prospective population-based study of 182 309 deliveries in France between 2012 and 2013. Transfusion practices and compliance with French national guidelines were described for all women with severe postpartum hemorrhage who had been transfused with red blood cells.ResultsIn 1495 women with severe postpartum hemorrhage (0.8% of all deliveries), 35.1% were not transfused, 50.0% were transfused during active bleeding and 14.9% exclusively after control of bleeding. Among 697 women with a hemoglobin level <7 g/dL, 21.4% were not transfused. In 747 women transfused during active bleeding, 68.8% also received fresh frozen plasma (fresh frozen plasma to red blood cell ratio between 0.5 and 1 in 80.4%). Forty-four percent received fibrinogen concentrate (including 37.4% with a plasma fibrinogen level >2 g/L) and 8.6% had a massive transfusion. Among 223 women transfused after bleeding was controlled, 5.4% received fresh frozen plasma and 13% had a hemoglobin level >7 g/dL.ConclusionsOne in five women with severe postpartum hemorrhage and a low hemoglobin concentration did not receive blood transfusion, which does not comply with French national recommendations. Over-transfusion occurred in women in whom bleeding had been controlled. The use of tools to help clinicians with transfusion decision-making should be developed.Copyright © 2019 Elsevier Ltd. All rights reserved.

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