title: An observational study of the fresh frozen plasma: red blood cell ratio in postpartum hemorrhage.
abstract: BACKGROUND
  Postpartum hemorrhage is the leading cause of maternal death worldwide. Recent data from trauma patients and patients with hemorrhagic shock have suggested that an increased fresh frozen plasma:red blood cell (FFP:RBC) ratio may be of benefit in massive bleeding. We addressed this issue in cases of severe postpartum hemorrhage.
  
  
  METHODS
  We reviewed data from all patients diagnosed with severe postpartum hemorrhage during a 4-year period (2006-2009). Patients who were treated with sulprostone and required transfusion within 6 hours of delivery were included in the study and were divided into 2 groups according to their response to sulprostone: bleeding controlled with sulprostone alone (sulprostone group) and bleeding requiring an additional advanced interventional procedure including arterial angiographic embolization and/or surgical procedures (arterial ligation, B-Lynch suture, or hysterectomy; intervention group). The requirement or no requirement for advanced procedures constituted the primary end point of the study. Propensity scoring was used to assess the effect of a high FFP:RBC ratio on bleeding control.
  
  
  RESULTS
  Among 12,226 deliveries during the study period, 142 (1.1%) were complicated by severe postpartum hemorrhage. Bleeding was controlled with sulprostone alone in 90 patients (63%). Advanced interventional procedures were required for 52 patients (37%). Forty-one patients were transfused with both RBCs and FFP. The FFP:RBC ratio increased over the study period (P < 0.001), from 1:1.8 at the start to 1:1.1 at the end of the study period. After propensity score modeling (inverse probability of treatment weighting), a high FFP:RBC ratio was associated with lower odds for advanced interventional procedures (odds ratio [95% confidence interval], 1.25 [1.07-1.47]; P = 0.008). There were no deaths, severe organ dysfunction, or other complications as a consequence of severe postpartum hemorrhage.
  
  
  CONCLUSIONS
  In this retrospective study, a higher FFP:RBC ratio was associated with a lower requirement for advanced interventional procedures in the setting of postpartum hemorrhage. The benefits of transfusion using a higher FFP:RBC ratio should be confirmed by randomized-controlled trials.
authors.affiliation: Bégin Military Teaching Hospital, 69 avenue de Paris 94163 Saint-Mandé Cedex, France. pasquier9606@yahoo.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Pasquier
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
authors.forename: Thibaut
authors.initials: T
authors.lastname: Rackelboom
authors.forename: Julien
authors.initials: J
authors.lastname: La Rosa
authors.forename: Abeer
authors.initials: A
authors.lastname: Tashkandi
authors.forename: Antoine
authors.initials: A
authors.lastname: Tesniere
authors.forename: Julie
authors.initials: J
authors.lastname: Ravinet
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.forename: Vassilis
authors.initials: V
authors.lastname: Tsatsaris
authors.forename: Yves
authors.initials: Y
authors.lastname: Ozier
authors.forename: François
authors.initials: F
authors.lastname: Goffinet
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mignon
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical; D000792:Angiography; D001724:Birth Weight; D002585:Cesarean Section; D015232:Dinoprostone / Q000031:analogs & derivatives / Q000627:therapeutic use; D004621:Embolization, Therapeutic; D004906:Erythrocyte Count; D004912:Erythrocytes / Q000502:physiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008600:Menstruation-Inducing Agents / Q000627:therapeutic use; D016017:Odds Ratio; D010949:Plasma; D006473:Postpartum Hemorrhage / Q000097:blood* / Q000601:surgery / Q000628:therapy*; D011247:Pregnancy; D057216:Propensity Score; D012307:Risk Factors
chemical_list: D008600:Menstruation-Inducing Agents; C016767:sulprostone; D015232:Dinoprostone