title: [Transfusion strategy for patients with severe postpartum hemorrhage: a retrospective study of 47 cases].
abstract: BACKGROUND
  Postpartum haemorrhage is the leading cause of maternal morbidity and mortality worldwide. It requires a multidisciplinary approach. Transfusion strategy is essential, playing a key role in maternal prognosis. This study aims to determine FFP/RBC ratio (plasma frais congelé/concentrés de globules rouges; fresh frozen plasma/red blood cells) during the treatment of serious postpartum haemorrhages.
  
  
  METHODS
  We conducted a retrospective study at a Maternity Referral Center (level III) in eastern Tunisia over a period of 4 years (2009-2012). All parturients admitted due to severe postpartum bleeding requiring transfusion of more than 4 Units of RBC during the first 3 hours or of more than 10 Units of RBC during the first 24 hours of treatment were included in the study.
  
  
  RESULTS
  47 parturients were enrolled in our study. The diagnosis of PPH was made on the basis of vaginal bleeding in 28 cases and following cesarean section in 19 cases. Preoperative hemoglobin level was of 6.3 g/dl. Transfusion ratio (FFP/RBC) was 1/0.7.
  
  
  CONCLUSIONS
  During tratment transfusion ratio was greater than that indicated in the existing guidelines stating an early and massive administration of FFP with a FFP/RBC ratio ranging between 1/2 and 1/1. Fibrinogen (Fbg) and tranexamic acid should be administered as early as possible. The use of recombinant activated factor VII (rFVIIa) should remain the ultimate treatment option.
authors.affiliation: Service Anesthésie Réanimation chirurgicale, Centre Hospitalo-Universitaire Farhat Hached Sousse-Tunisie; Unité de Recherche UR12SP32, CHU Farhat Hached, Sousse, Tunisie.
authors.forename: Hosni
authors.initials: H
authors.lastname: Khouadja
authors.affiliation: Service Anesthésie Réanimation chirurgicale, Centre Hospitalo-Universitaire Farhat Hached Sousse-Tunisie.
authors.forename: Wissem
authors.initials: W
authors.lastname: Rouissi
authors.affiliation: Service d'Hygiène Hospitalière. Centre Hospitalo-Universitaire Farhat Hached Sousse, Tunisie.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mahjoub
authors.affiliation: Unité de Recherche UR12SP32, CHU Farhat Hached, Sousse, Tunisie.
authors.forename: Jaballah
authors.initials: J
authors.lastname: Sakhri
authors.affiliation: Service Anesthésie Réanimation chirurgicale, Centre Hospitalo-Universitaire Farhat Hached Sousse-Tunisie.
authors.forename: Dhafer
authors.initials: D
authors.lastname: Beletaifa
authors.affiliation: Service Anesthésie Réanimation chirurgicale, Centre Hospitalo-Universitaire Farhat Hached Sousse-Tunisie.
authors.forename: Khaled Ben
authors.initials: KB
authors.lastname: Jazia
mesh_terms: D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion / Q000379:methods*; D002585:Cesarean Section; D017707:Erythrocyte Transfusion / Q000379:methods*; D015942:Factor VIIa / Q000008:administration & dosage; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage; D006801:Humans; D010949:Plasma; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D011994:Recombinant Proteins / Q000008:administration & dosage; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014148:Tranexamic Acid / Q000008:administration & dosage; D014416:Tunisia; D055815:Young Adult
chemical_list: D011994:Recombinant Proteins; D014148:Tranexamic Acid; D005340:Fibrinogen; C103587:recombinant FVIIa; D015942:Factor VIIa
keywords: Severe postpartum hemorrhage; blood transfusion; maternal morbidity and mortality