Association of Timing of Plasma Transfusion With Adverse Maternal Outcomes in Women With Persistent Postpartum Hemorrhage

Dacia D. C. A. Henriquez; Camila Caram-Deelder; Saskia le Cessie; Joost J. Zwart; Jos J. M. van Roosmalen; Jeroen C. J. Eikenboom; Cynthia So-Osman; Leom. G. van de Watering; Jaap Jan Zwaginga; Ankie W. M. M. Koopman-van Gemert; Kitty W. M. Bloemenkamp; Johanna G. van der Bom; Cock M. C. Bank; Yvette S. Snuif-de Lange; Adriaan J. van Gammeren; Dimitri N. M. Papatsonis; Harriet Klinkspoor; Marjolein Kok; Bauke A. de Boer; Josje Langenveld; Mathie P. G. Leers; Jart H. C. Diris; Rene D. Kok; Paula Engbers; Marjo J. C. P. Hanssen; Wim J. van Wijngaarden; Daniela H. Schippers; Josw. J. van der Stappen; Tom H. M. Hasaart; Daan H. van de Kerkhof; Jacques B. de Kok; Gijs A. van Unnik; Wouter Kortlandt; Nicow. E. Schuitemaker; Friso M. C. Delemarre; Hans L. P. van Duijnhoven; Hans J. Duvekot; Sietske Hogenboom; Gunilla Kleiverda; Mylene J. W. van Etten-van Hulst; Karin Pagano Mirani-Oostdijk; Corine van Kampen; Martin J. N. Weinans; Henk J. Adriaanse; Jeffrey F. W. Keuren; Yvonne M. C. Henskens; Liesbeth H. C. J. Scheepers; Marjolein J. de Vries; Lenneke Prinzen; TeMpOH-1 Research Group

doi:10.1001/jamanetworkopen.2019.15628

Association of Timing of Plasma Transfusion With Adverse Maternal Outcomes in Women With Persistent Postpartum Hemorrhage

Dacia D. C. A. Henriquez^*, Camila Caram-Deelder, Saskia le Cessie, Joost J. Zwart, Jos J. M. van Roosmalen, Jeroen C. J. Eikenboom, Cynthia So-Osman, Leom. G. van de Watering, Jaap Jan Zwaginga, Ankie W. M. M. Koopman-van Gemert, Kitty W. M. Bloemenkamp, Johanna G. van der Bom, Cock M. C. Bank, Yvette S. Snuif-de Lange, Adriaan J. van Gammeren, Dimitri N. M. Papatsonis, Harriet Klinkspoor, Marjolein Kok, Bauke A. de Boer, Josje LangenveldMathie P. G. Leers, Jart H. C. Diris, Rene D. Kok, Paula Engbers, Marjo J. C. P. Hanssen, Wim J. van Wijngaarden, Daniela H. Schippers, Josw. J. van der Stappen, Tom H. M. Hasaart, Daan H. van de Kerkhof, Jacques B. de Kok, Gijs A. van Unnik, Wouter Kortlandt, Nicow. E. Schuitemaker, Friso M. C. Delemarre, Hans L. P. van Duijnhoven, Hans J. Duvekot, Sietske Hogenboom, Gunilla Kleiverda, Mylene J. W. van Etten-van Hulst, Karin Pagano Mirani-Oostdijk, Corine van Kampen, Martin J. N. Weinans, Henk J. Adriaanse, Jeffrey F. W. Keuren, Yvonne M. C. Henskens, Liesbeth H. C. J. Scheepers, Marjolein J. de Vries, Lenneke Prinzen, TeMpOH-1 Research Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

IMPORTANCE Early plasma transfusion for women with severe postpartum hemorrhage (PPH) is recommended to prevent coagulopathy. However, there is no comparative, quantitative evidence on the association of early plasma transfusion with maternal outcomes.

OBJECTIVE To compare the incidence of adverse maternal outcomes among women who received plasma during the first 60 minutes of persistent PPH vs women who did not receive plasma for similarly severe persistent PPH.

DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study used a consecutive sample of women with persistent PPH, defined as PPH refractory to first-line measures to control bleeding, between January 1, 2011, and January 1, 2013. Time-dependent propensity score matching was used to select women who received plasma during the first 60 minutes of persistent PPH and match each of them with a woman who had shown the same severity and received the same treatment of PPH but who had not received plasma at the moment of matching. Transfusions were not guided by coagulation tests. Statistical analysis was performed from June 2018 to June 2019.

EXPOSURES Transfusion of plasma during the first 60 minutes of persistent PPH vs no or later plasma transfusion.

MAIN OUTCOMES AND MEASURES Incidence of adverse maternal outcomes, defined as a composite of death, hysterectomy, or arterial embolization.

RESULTS This study included 1216 women (mean [SD] age, 31.6 [5.0] years) with persistent PPH, of whom 932 (76.6%) delivered vaginally and 780 (64.1%) had PPH caused by uterine atony. Seven women (0.6%) died because of PPH, 62 women (5.1%) had a hysterectomy, and 159 women (13.1%) had arterial embolizations. Among women who received plasma during the first 60 minutes of persistent PPH, 114 women could be matched with a comparable woman who had not received plasma at the moment of matching. The incidence of adverse maternal outcomes was similar between the women, with adverse outcomes recorded in 24 women (21.2%) who received early plasma transfusion and 23 women (19.9%) who did not receive early plasma transfusion (odds ratio, 1.09; 95% CI, 0.57-2.09). Results of sensitivity analyses were comparable to the primary results.

CONCLUSIONS AND RELEVANCE In this cohort study, initiation of plasma transfusion during the first 60 minutes of persistent PPH was not associated with adverse maternal outcomes compared with no or later plasma transfusion, independent of severity of PPH.

Original language	English
Article number	1915628
Number of pages	16
Journal	Jama network open
Volume	2
Issue number	11
DOIs	https://doi.org/10.1001/jamanetworkopen.2019.15628
Publication status	Published - Nov 2019

Keywords

PROPENSITY SCORE ANALYSIS
HOSPITAL CARDIAC-ARREST
FIBRINOGEN CONCENTRATE
MULTIPLE IMPUTATION
TRACHEAL INTUBATION
TRANEXAMIC ACID
DOUBLE-BLIND
BALANCE
COAGULOPATHY
MANAGEMENT

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Henriquez, D. D. C. A., Caram-Deelder, C., le Cessie, S., Zwart, J. J., van Roosmalen, J. J. M., Eikenboom, J. C. J., So-Osman, C., van de Watering, L. G., Zwaginga, J. J., Koopman-van Gemert, A. W. M. M., Bloemenkamp, K. W. M., van der Bom, J. G., Bank, C. M. C., Snuif-de Lange, Y. S., van Gammeren, A. J., Papatsonis, D. N. M., Klinkspoor, H., Kok, M., de Boer, B. A., ... TeMpOH-1 Research Group (2019). Association of Timing of Plasma Transfusion With Adverse Maternal Outcomes in Women With Persistent Postpartum Hemorrhage. Jama network open, 2(11), Article 1915628. https://doi.org/10.1001/jamanetworkopen.2019.15628

@article{7db4b927f6334e60a77989aa180c0cad,

title = "Association of Timing of Plasma Transfusion With Adverse Maternal Outcomes in Women With Persistent Postpartum Hemorrhage",

abstract = "IMPORTANCE Early plasma transfusion for women with severe postpartum hemorrhage (PPH) is recommended to prevent coagulopathy. However, there is no comparative, quantitative evidence on the association of early plasma transfusion with maternal outcomes.OBJECTIVE To compare the incidence of adverse maternal outcomes among women who received plasma during the first 60 minutes of persistent PPH vs women who did not receive plasma for similarly severe persistent PPH.DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study used a consecutive sample of women with persistent PPH, defined as PPH refractory to first-line measures to control bleeding, between January 1, 2011, and January 1, 2013. Time-dependent propensity score matching was used to select women who received plasma during the first 60 minutes of persistent PPH and match each of them with a woman who had shown the same severity and received the same treatment of PPH but who had not received plasma at the moment of matching. Transfusions were not guided by coagulation tests. Statistical analysis was performed from June 2018 to June 2019.EXPOSURES Transfusion of plasma during the first 60 minutes of persistent PPH vs no or later plasma transfusion.MAIN OUTCOMES AND MEASURES Incidence of adverse maternal outcomes, defined as a composite of death, hysterectomy, or arterial embolization.RESULTS This study included 1216 women (mean [SD] age, 31.6 [5.0] years) with persistent PPH, of whom 932 (76.6%) delivered vaginally and 780 (64.1%) had PPH caused by uterine atony. Seven women (0.6%) died because of PPH, 62 women (5.1%) had a hysterectomy, and 159 women (13.1%) had arterial embolizations. Among women who received plasma during the first 60 minutes of persistent PPH, 114 women could be matched with a comparable woman who had not received plasma at the moment of matching. The incidence of adverse maternal outcomes was similar between the women, with adverse outcomes recorded in 24 women (21.2%) who received early plasma transfusion and 23 women (19.9%) who did not receive early plasma transfusion (odds ratio, 1.09; 95% CI, 0.57-2.09). Results of sensitivity analyses were comparable to the primary results.CONCLUSIONS AND RELEVANCE In this cohort study, initiation of plasma transfusion during the first 60 minutes of persistent PPH was not associated with adverse maternal outcomes compared with no or later plasma transfusion, independent of severity of PPH.",

keywords = "PROPENSITY SCORE ANALYSIS, HOSPITAL CARDIAC-ARREST, FIBRINOGEN CONCENTRATE, MULTIPLE IMPUTATION, TRACHEAL INTUBATION, TRANEXAMIC ACID, DOUBLE-BLIND, BALANCE, COAGULOPATHY, MANAGEMENT",

author = "Henriquez, {Dacia D. C. A.} and Camila Caram-Deelder and {le Cessie}, Saskia and Zwart, {Joost J.} and {van Roosmalen}, {Jos J. M.} and Eikenboom, {Jeroen C. J.} and Cynthia So-Osman and {van de Watering}, {Leom. G.} and Zwaginga, {Jaap Jan} and {Koopman-van Gemert}, {Ankie W. M. M.} and Bloemenkamp, {Kitty W. M.} and {van der Bom}, {Johanna G.} and Bank, {Cock M. C.} and {Snuif-de Lange}, {Yvette S.} and {van Gammeren}, {Adriaan J.} and Papatsonis, {Dimitri N. M.} and Harriet Klinkspoor and Marjolein Kok and {de Boer}, {Bauke A.} and Josje Langenveld and Leers, {Mathie P. G.} and Diris, {Jart H. C.} and Kok, {Rene D.} and Paula Engbers and Hanssen, {Marjo J. C. P.} and {van Wijngaarden}, {Wim J.} and Schippers, {Daniela H.} and {van der Stappen}, {Josw. J.} and Hasaart, {Tom H. M.} and {van de Kerkhof}, {Daan H.} and {de Kok}, {Jacques B.} and {van Unnik}, {Gijs A.} and Wouter Kortlandt and Schuitemaker, {Nicow. E.} and Delemarre, {Friso M. C.} and {van Duijnhoven}, {Hans L. P.} and Duvekot, {Hans J.} and Sietske Hogenboom and Gunilla Kleiverda and {van Etten-van Hulst}, {Mylene J. W.} and Mirani-Oostdijk, {Karin Pagano} and {van Kampen}, Corine and Weinans, {Martin J. N.} and Adriaanse, {Henk J.} and Keuren, {Jeffrey F. W.} and Henskens, {Yvonne M. C.} and Scheepers, {Liesbeth H. C. J.} and {de Vries}, {Marjolein J.} and Lenneke Prinzen and {TeMpOH-1 Research Group}",

year = "2019",

month = nov,

doi = "10.1001/jamanetworkopen.2019.15628",

language = "English",

volume = "2",

journal = "Jama network open",

issn = "2574-3805",

publisher = "American Medical Association",

number = "11",

}

Henriquez, DDCA, Caram-Deelder, C, le Cessie, S, Zwart, JJ, van Roosmalen, JJM, Eikenboom, JCJ, So-Osman, C, van de Watering, LG, Zwaginga, JJ, Koopman-van Gemert, AWMM, Bloemenkamp, KWM, van der Bom, JG, Bank, CMC, Snuif-de Lange, YS, van Gammeren, AJ, Papatsonis, DNM, Klinkspoor, H, Kok, M, de Boer, BA, Langenveld, J, Leers, MPG, Diris, JHC, Kok, RD, Engbers, P, Hanssen, MJCP, van Wijngaarden, WJ, Schippers, DH, van der Stappen, JJ, Hasaart, THM, van de Kerkhof, DH, de Kok, JB, van Unnik, GA, Kortlandt, W, Schuitemaker, NE, Delemarre, FMC, van Duijnhoven, HLP, Duvekot, HJ, Hogenboom, S, Kleiverda, G, van Etten-van Hulst, MJW, Mirani-Oostdijk, KP, van Kampen, C, Weinans, MJN, Adriaanse, HJ, Keuren, JFW, Henskens, YMC , Scheepers, LHCJ, de Vries, MJ, Prinzen, L & TeMpOH-1 Research Group 2019, 'Association of Timing of Plasma Transfusion With Adverse Maternal Outcomes in Women With Persistent Postpartum Hemorrhage', Jama network open, vol. 2, no. 11, 1915628. https://doi.org/10.1001/jamanetworkopen.2019.15628

TY - JOUR

T1 - Association of Timing of Plasma Transfusion With Adverse Maternal Outcomes in Women With Persistent Postpartum Hemorrhage

AU - Henriquez, Dacia D. C. A.

AU - Caram-Deelder, Camila

AU - le Cessie, Saskia

AU - Zwart, Joost J.

AU - van Roosmalen, Jos J. M.

AU - Eikenboom, Jeroen C. J.

AU - So-Osman, Cynthia

AU - van de Watering, Leom. G.

AU - Zwaginga, Jaap Jan

AU - Koopman-van Gemert, Ankie W. M. M.

AU - Bloemenkamp, Kitty W. M.

AU - van der Bom, Johanna G.

AU - Bank, Cock M. C.

AU - Snuif-de Lange, Yvette S.

AU - van Gammeren, Adriaan J.

AU - Papatsonis, Dimitri N. M.

AU - Klinkspoor, Harriet

AU - Kok, Marjolein

AU - de Boer, Bauke A.

AU - Langenveld, Josje

AU - Leers, Mathie P. G.

AU - Diris, Jart H. C.

AU - Kok, Rene D.

AU - Engbers, Paula

AU - Hanssen, Marjo J. C. P.

AU - van Wijngaarden, Wim J.

AU - Schippers, Daniela H.

AU - van der Stappen, Josw. J.

AU - Hasaart, Tom H. M.

AU - van de Kerkhof, Daan H.

AU - de Kok, Jacques B.

AU - van Unnik, Gijs A.

AU - Kortlandt, Wouter

AU - Schuitemaker, Nicow. E.

AU - Delemarre, Friso M. C.

AU - van Duijnhoven, Hans L. P.

AU - Duvekot, Hans J.

AU - Hogenboom, Sietske

AU - Kleiverda, Gunilla

AU - van Etten-van Hulst, Mylene J. W.

AU - Mirani-Oostdijk, Karin Pagano

AU - van Kampen, Corine

AU - Weinans, Martin J. N.

AU - Adriaanse, Henk J.

AU - Keuren, Jeffrey F. W.

AU - Henskens, Yvonne M. C.

AU - Scheepers, Liesbeth H. C. J.

AU - de Vries, Marjolein J.

AU - Prinzen, Lenneke

AU - TeMpOH-1 Research Group

PY - 2019/11

Y1 - 2019/11

N2 - IMPORTANCE Early plasma transfusion for women with severe postpartum hemorrhage (PPH) is recommended to prevent coagulopathy. However, there is no comparative, quantitative evidence on the association of early plasma transfusion with maternal outcomes.OBJECTIVE To compare the incidence of adverse maternal outcomes among women who received plasma during the first 60 minutes of persistent PPH vs women who did not receive plasma for similarly severe persistent PPH.DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study used a consecutive sample of women with persistent PPH, defined as PPH refractory to first-line measures to control bleeding, between January 1, 2011, and January 1, 2013. Time-dependent propensity score matching was used to select women who received plasma during the first 60 minutes of persistent PPH and match each of them with a woman who had shown the same severity and received the same treatment of PPH but who had not received plasma at the moment of matching. Transfusions were not guided by coagulation tests. Statistical analysis was performed from June 2018 to June 2019.EXPOSURES Transfusion of plasma during the first 60 minutes of persistent PPH vs no or later plasma transfusion.MAIN OUTCOMES AND MEASURES Incidence of adverse maternal outcomes, defined as a composite of death, hysterectomy, or arterial embolization.RESULTS This study included 1216 women (mean [SD] age, 31.6 [5.0] years) with persistent PPH, of whom 932 (76.6%) delivered vaginally and 780 (64.1%) had PPH caused by uterine atony. Seven women (0.6%) died because of PPH, 62 women (5.1%) had a hysterectomy, and 159 women (13.1%) had arterial embolizations. Among women who received plasma during the first 60 minutes of persistent PPH, 114 women could be matched with a comparable woman who had not received plasma at the moment of matching. The incidence of adverse maternal outcomes was similar between the women, with adverse outcomes recorded in 24 women (21.2%) who received early plasma transfusion and 23 women (19.9%) who did not receive early plasma transfusion (odds ratio, 1.09; 95% CI, 0.57-2.09). Results of sensitivity analyses were comparable to the primary results.CONCLUSIONS AND RELEVANCE In this cohort study, initiation of plasma transfusion during the first 60 minutes of persistent PPH was not associated with adverse maternal outcomes compared with no or later plasma transfusion, independent of severity of PPH.

AB - IMPORTANCE Early plasma transfusion for women with severe postpartum hemorrhage (PPH) is recommended to prevent coagulopathy. However, there is no comparative, quantitative evidence on the association of early plasma transfusion with maternal outcomes.OBJECTIVE To compare the incidence of adverse maternal outcomes among women who received plasma during the first 60 minutes of persistent PPH vs women who did not receive plasma for similarly severe persistent PPH.DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study used a consecutive sample of women with persistent PPH, defined as PPH refractory to first-line measures to control bleeding, between January 1, 2011, and January 1, 2013. Time-dependent propensity score matching was used to select women who received plasma during the first 60 minutes of persistent PPH and match each of them with a woman who had shown the same severity and received the same treatment of PPH but who had not received plasma at the moment of matching. Transfusions were not guided by coagulation tests. Statistical analysis was performed from June 2018 to June 2019.EXPOSURES Transfusion of plasma during the first 60 minutes of persistent PPH vs no or later plasma transfusion.MAIN OUTCOMES AND MEASURES Incidence of adverse maternal outcomes, defined as a composite of death, hysterectomy, or arterial embolization.RESULTS This study included 1216 women (mean [SD] age, 31.6 [5.0] years) with persistent PPH, of whom 932 (76.6%) delivered vaginally and 780 (64.1%) had PPH caused by uterine atony. Seven women (0.6%) died because of PPH, 62 women (5.1%) had a hysterectomy, and 159 women (13.1%) had arterial embolizations. Among women who received plasma during the first 60 minutes of persistent PPH, 114 women could be matched with a comparable woman who had not received plasma at the moment of matching. The incidence of adverse maternal outcomes was similar between the women, with adverse outcomes recorded in 24 women (21.2%) who received early plasma transfusion and 23 women (19.9%) who did not receive early plasma transfusion (odds ratio, 1.09; 95% CI, 0.57-2.09). Results of sensitivity analyses were comparable to the primary results.CONCLUSIONS AND RELEVANCE In this cohort study, initiation of plasma transfusion during the first 60 minutes of persistent PPH was not associated with adverse maternal outcomes compared with no or later plasma transfusion, independent of severity of PPH.

KW - PROPENSITY SCORE ANALYSIS

KW - HOSPITAL CARDIAC-ARREST

KW - FIBRINOGEN CONCENTRATE

KW - MULTIPLE IMPUTATION

KW - TRACHEAL INTUBATION

KW - TRANEXAMIC ACID

KW - DOUBLE-BLIND

KW - BALANCE

KW - COAGULOPATHY

KW - MANAGEMENT

U2 - 10.1001/jamanetworkopen.2019.15628

DO - 10.1001/jamanetworkopen.2019.15628

M3 - Article

C2 - 31730187

SN - 2574-3805

VL - 2

JO - Jama network open

JF - Jama network open

IS - 11

M1 - 1915628

ER -

Association of Timing of Plasma Transfusion With Adverse Maternal Outcomes in Women With Persistent Postpartum Hemorrhage

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Keywords

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