Background
The view that 2 l of crystalloid and 1.5 l of colloid can be infused while awaiting compatible blood for patients with major postpartum haemorrhage is based on expert opinion documents. We describe real-world changes in levels of coagulation parameters after the administration of different volumes of clear fluids to women suffering from major postpartum haemorrhage.
Methods
We performed a nationwide retrospective cohort study in the Netherlands among 1038 women experiencing severe postpartum haemorrhage who had received at least four units of red cells or fresh frozen plasma or platelets in addition to red cells. The volume of clear fluids administered before the time of blood sampling was classified into three fluid administration strategies, based on the RCOG guideline: < 2 L, 2-3.5 L and > 3.5 L. Outcomes included haemoglobin, haematocrit, platelet count, fibrinogen, aPTT and PT levels.
Results
Haemoglobin, haematocrit, platelet count, fibrinogen and aPTT were associated with volumes of clear fluids, which was most pronounced early during the course of postpartum haemorrhage. During the earliest phases of postpartum haemorrhage median haemoglobin level was 10.1 g/dl (IQR 8.5-11.6) among the women who received < 2 L clear fluids and 8.1 g/dl (IQR 7.1-8.4) among women who received > 3.5 L of clear fluids; similarly median platelet counts were 181 × 109/litre (IQR 131-239) and 89 × 109/litre (IQR 84-135), aPTT 29 s (IQR 27-33) and 38 s (IQR 35-55) and fibrinogen 3.9 g/L (IQR 2.5-5.2) and 1.6 g/L (IQR 1.3-2.1).
Conclusions
In this large cohort of women with severe postpartum haemorrhage, administration of larger volumes of clear fluids was associated with more severe deterioration of coagulation parameters corresponding to dilution. Our findings provide thus far the best available evidence to support expert opinion-based guidelines recommending restrictive fluid resuscitation in women experiencing postpartum haemorrhage.
Trial registration
Netherlands Trial Register ( NTR4079 ), registration date July 17, 2013.
Overview publication
| Title | Association between fluid management and dilutional coagulopathy in severe postpartum haemorrhage: a nationwide retrospective cohort study. |
| Date | October 11th, 2018 |
| Issue name | BMC pregnancy and childbirth |
| Issue number | v18.1:398 |
| DOI | 10.1186/s12884-018-2021-9 |
| PubMed | 30305108 |
| Authors | |
| Info | TeMpOH-1 study group, Adriaanse HJ, van den Akker ESA, Baas MI, Bank CMC, van Beek E, de Boer BA, de Boer K, van der Borden DMR, Bremer HA, Brons JTJ, Burggraaff JM, Ceelie H, Chon H, Cikot JLM, Delemarre FMC, Diris JHC, Doesburg-van Kleffens M, van Dooren IMA, van Duijnhoven JLP, van Dunné FM, Duvekot JJ, Engbers P, van Etten-van Hulst MJW, Feitsma H, Fouraux MA, Franssen MTM, Frasa MAM, van Gammeren AJ, van Gemund N, van der Graaf F, de Groot CJM, Hackeng CM, van der Ham DP, Hanssen MJCP, Hasaart THM, Hendriks HA, Henskens YMC, Hermsen BBJ, Hogenboom S, Hooker A, Hudig F, Huijssoon AMG, Huisjes AJM, Jonker N, Kabel PJ, van Kampen C, de Keijzer MH, van de Kerkhof DH, Keuren JFW, Keuren JFW, Kleiverda G, Klinkspoor JH, Koehorst SGA, Kok M, Kok RD, de Kok JB, Koops A, Kortlandt W, Langenveld J, Leers MPG, Leyte A, de Mare A, Martens GDM, Meekers JH, van Meir CA, Metz GCH, Michielse ECHJ, Mostert LJ, Nij Bijvank SWH, Oostenveld E, Osmanovic N, Oudijk MA, Pagano Mirani-Oostdijk C, van Pampus ECM, Papatsonis DNM, Peters RHM, Ponjee GAE, Pontesilli M, Porath MM, Post MS, Pouwels JGJ, Prinzen L, Roelofsen JMT, Rondeel JJM, van der Salm PCM, Scheepers HCJ, Schippers DH, Schuitemaker NWE, Sikkema JM, Slomp J, Smit JW, Snuif-de Lange YS, van der Stappen JWJ, Steures P, Tax GHM, Treskes M, Ulenkate HJLM, van Unnik GA, van der Veen BS, Verhagen TEM, Versendaal J, Visschers B, Visser O, Visser H, de Vooght KMK, de Vries MJ, de Waard H, Weerkamp F, Weinans MJN, de Wet H, van Wijnen M, van Wijngaarden WJ, de Wit AC, Woiski MD |
| Keywords | Coagulation parameters, Dilutional coagulopathy, Fluid management, Postpartum haemorrhage |
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