Efficacy of transfusion with fresh-frozen plasma:red blood cell concentrate ratio of 1 or more for amniotic fluid embolism with coagulopathy: a case-control study.
The Japan Association of Obstetricians and Gynecologists (JAOG) recommends transfusion with a fresh-frozen plasma (FFP):red blood cell (RBC) ratio of 1 or more in postpartum hemorrhage. However, no global consensus exists concerning this, and little is known regarding the impact of FFP:RBC ratio on maternal mortality. This study evaluates the efficacy of transfusion with FFP:RBC ratio of 1 or more for amniotic fluid embolism (AFE) with coagulopathy.



The Maternal Death Exploratory Committee, established by the JAOG, conducted this retrospective nationwide case-control study in Japan. Women with AFE and coagulopathy were included in the study and were stratified into survival and death groups. Obstetric variables and therapy methods (hysterectomy, uterine artery embolism, and transfusion with FFP:RBC ratio ≥ 1) were compared between the survival and death groups.



A total of 54 women had AFE and coagulopathy (death group, n = 22; survival group, n = 32). Only nine (40.9%) women in the death group were transfused with FFP:RBC ratio of 1 or more, whereas 29 (90.6%) women in the survival group were transfused with FFP:RBC ratio of 1 or more. FFP:RBC ratio of 1 or more was found to be associated with better survival rate (adjusted odds ratio, 28.32; 95% confidence interval, 4.26-188.37). No difference was found in obstetric variables, hysterectomy, and uterine artery embolism between survival and death groups.



Transfusion with FFP:RBC ratio of 1 or more is associated with higher survival rate in women with AFE with coagulopathy.
Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan.
Hiroaki
H
Tanaka
Department of Obstetrics and Gynecology, Sakakibara Heart Institute.
Shinji
S
Katsuragi
Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan.
Kazuhiro
K
Osato
Department of Obstetrics and Gynecology, Showa University School of Medicine.
Junichi
J
Hasegawa
Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan.
Masahiko
M
Nakata
Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
Takeshi
T
Murakoshi
Division of Maternal Fetal Medicine and Gynecology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Jun
J
Yoshimatsu
Department of Obstetrics and Gynecology, Showa University School of Medicine.
Akihiko
A
Sekizawa
Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Shizuoka, Japan.
Naohiro
N
Kanayama
Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan.
Isamu
I
Ishiwata
Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan.
Tomoaki
T
Ikeda
D000328:Adult; D001778:Blood Coagulation Disorders / Q000401:mortality / Q000628:therapy*; D016022:Case-Control Studies; D004619:Embolism, Amniotic Fluid / Q000401:mortality / Q000628:therapy*; D017707:Erythrocyte Transfusion / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D007564:Japan; D010949:Plasma; D006473:Postpartum Hemorrhage / Q000401:mortality / Q000628:therapy; D011247:Pregnancy; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult