Early plasma transfusion may benefit women with persistent PPH : JAMA

Netherlands: Early initiation of plasma transfusion during the first 60 minutes of persistent postpartum haemorrhage (PPH) compared with no or later plasma did not lead to adverse maternal outcomes, a recent study published in the JAMA Network Open journal has found.

Obstetric haemorrhage accounts for 27% of all maternal deaths. In high-source settings, maternal death due to PPH has become uncommon but still, PPH remains an important cause of severe maternal morbidity. Persistent PPH can increase the risk of coagulopathy in women due to the depletion of coagulation factors and platelets. Coagulopathy -- a condition in which the blood's ability to coagulate (form clots) is impaired -- can eventually lead to worse maternal outcomes. Timely transfusion of plasma may prevent coagulopathy and thereby improve maternal outcomes.

Whether transfusion of plasma is associated with better maternal outcomes in women with persistent PPH is not clear. The formulaic plasma transfusion comprises of a fixed ratio of plasma to red blood cells (RBCs).

Dacia Henriquez, Leiden University Medical Center, Leiden, the Netherlands, and colleagues compared 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.

This multicenter cohort 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. 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.

The participants were exposed to transfusion of plasma during the first 60 minutes of persistent PPH vs no or later plasma transfusion.

Incidence of adverse maternal outcomes, defined as a composite of death, hysterectomy, or arterial embolization were the main outcomes and measures of the study.

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Key findings of the study include:

• 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.


• The results of sensitivity analyses were comparable to the primary results.

Read Also: Women with anemia twice as likely to need transfusion after cesarean delivery

"Our findings do not suggest that plasma transfusion has no place in the treatment of women with severe PPH. Rather, our study underlines the importance of developing tools to diagnose coagulopathy during persistent PPH. These tools may enable individualization of treatment of women with persistent PPH by identifying women who develop coagulopathy during persistent PPH," wrote the authors.

The study, "Association of Timing of Plasma Transfusion With Adverse Maternal Outcomes in Women With Persistent Postpartum Hemorrhage," is published in the JAMA Network Open journal.

DOI: 10.1001/jamanetworkopen.2019.15628

Journal Information: JAMA Network Open