Fluid resuscitation during persistent postpartum haemorrhage and maternal outcome: A nationwide cohort study

Dacia D. C. A. Henriquez, Kitty W. M. Bloemenkamp, Rosanne M. Loeff, Joost J. Zwart, Jos J. M. van Roosmalen, Jaap Jan Zwaginga, Johanna G. van der Bom

Research output: Contribution to journalArticleAcademicpeer-review

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.
Original languageEnglish
Pages (from-to)49-56
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
Volume235
DOIs
Publication statusPublished - 1 Apr 2019

Cite this

Henriquez, Dacia D. C. A. ; Bloemenkamp, Kitty W. M. ; Loeff, Rosanne M. ; Zwart, Joost J. ; van Roosmalen, Jos J. M. ; Zwaginga, Jaap Jan ; van der Bom, Johanna G. / Fluid resuscitation during persistent postpartum haemorrhage and maternal outcome: A nationwide cohort study. In: European Journal of Obstetrics and Gynecology and Reproductive Biology. 2019 ; Vol. 235. pp. 49-56.
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title = "Fluid resuscitation during persistent postpartum haemorrhage and maternal outcome: A nationwide 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.",
author = "Henriquez, {Dacia D. C. A.} and Bloemenkamp, {Kitty W. M.} and Loeff, {Rosanne M.} and Zwart, {Joost J.} and {van Roosmalen}, {Jos J. M.} and Zwaginga, {Jaap Jan} and {van der Bom}, {Johanna G.}",
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Fluid resuscitation during persistent postpartum haemorrhage and maternal outcome: A nationwide cohort study. / Henriquez, Dacia D. C. A.; Bloemenkamp, Kitty W. M.; Loeff, Rosanne M.; Zwart, Joost J.; van Roosmalen, Jos J. M.; Zwaginga, Jaap Jan; van der Bom, Johanna G.

In: European Journal of Obstetrics and Gynecology and Reproductive Biology, Vol. 235, 01.04.2019, p. 49-56.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Fluid resuscitation during persistent postpartum haemorrhage and maternal outcome: A nationwide cohort study

AU - Henriquez, Dacia D. C. A.

AU - Bloemenkamp, Kitty W. M.

AU - Loeff, Rosanne M.

AU - Zwart, Joost J.

AU - van Roosmalen, Jos J. M.

AU - Zwaginga, Jaap Jan

AU - van der Bom, Johanna G.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - 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.

AB - 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.

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