Predictive factors of advanced interventional procedures in a multicentre severe postpartum haemorrhage study

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• 作者：Etienne Gayat (1) (2) (3)
  Matthieu Resche-Rigon (2) (3)
  Olivier Morel (4)
  Matthias Rossignol (1)
  Jean Mantz (3) (5)
  Armelle Nicolas-Robin (6)
  Nathalie Nathan-Denizot (7)
  Jean-Yves Lefrant (8)
  Frédéric J. Mercier (9)
  Emmanuel Samain (10)
  Yann Fargeaudou (11)
  Emmanuel Barranger (3) (4)
  Marie-Josèphe Laisné (1)
  Pierre-Henri Bréchat (12)
  Dominique Luton (13) (3)
  Ingrid Ouanounou (1)
  Patricia Appa Plaza (1)
  Claire Broche (1)
  Didier Payen (1) (3)
  Alexandre Mebazaa (1) (14) (3)
  
• 关键词：Post ; partum hemorrhage ; Hemorrhagic shock ; Predictive score
• 刊名：Intensive Care Medicine
• 出版年：2011
• 出版时间：November 2011
• 年：2011
• 卷：37
• 期：11
• 页码：1816-1825
• 全文大小：1722KB
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  15. Audureau E, Deneux-Tharaux C, Lefevre P, Brucato S, Morello R, Dreyfus M, Bouvier-Colle MH (2009) Practices for prevention, diagnosis and management of postpartum haemorrhage: impact of a regional multifaceted intervention. BJOG 116:1325-333 CrossRef
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• 作者单位：Etienne Gayat (1) (2) (3)
  Matthieu Resche-Rigon (2) (3)
  Olivier Morel (4)
  Matthias Rossignol (1)
  Jean Mantz (3) (5)
  Armelle Nicolas-Robin (6)
  Nathalie Nathan-Denizot (7)
  Jean-Yves Lefrant (8)
  Frédéric J. Mercier (9)
  Emmanuel Samain (10)
  Yann Fargeaudou (11)
  Emmanuel Barranger (3) (4)
  Marie-Josèphe Laisné (1)
  Pierre-Henri Bréchat (12)
  Dominique Luton (13) (3)
  Ingrid Ouanounou (1)
  Patricia Appa Plaza (1)
  Claire Broche (1)
  Didier Payen (1) (3)
  Alexandre Mebazaa (1) (14) (3)
  
  1. Department of Anesthesiology and Critical Care Medicine, Mobile Care Unit, Lariboisière University Hospital, AP-HP, EA322, Paris Cedex 10, France
  2. Department of Biostatistics and Clinical Epidemiology, Saint-Louis University Hospital, AP-HP, INSERM UMR 717, Paris Cedex 10, France
  3. University Paris Diderot, Sorbonne Paris Cité, 75205, Paris, France
  4. Department of Obstetrics and Gynaecology, Lariboisière University Hospital, AP-HP, Paris Cedex 10, France
  5. Department of Anesthesiology and Critical Care Medicine, Mobile Care Unit, Beaujon University Hospital, AP-HP, Clichy-La Garenne, France
  6. Department of Anesthesia and Intensive Care, Mobile Care Unit, Pitié-Salpêtrière University Hospital, AP-HP, University Paris 6, Paris Cedex 13, France
  7. Department of Anesthesia and Intensive Care, Hopital Mère-enfant, Limoges, France
  8. Division Anesthésie Réanimation Douleur Urgences, Groupe Hospitalo-Universitaire Caremeau, CHU N?mes, N?mes, France
  9. Department of Anesthesiology and Critical Care Medicine, Antoine Béclère hospital, AP-HP, University Paris Sud 11, Clamart, France
  10. P?le d’anesthésie-réanimation chirurgicale, Center hospitalier universitaire Jean-Minjoz, Université de Franche-Comté, Besan?on, France
  11. Department of Radiology, Lariboisière University Hospital, AP-HP, Paris Cedex 10, France
  12. Research Laboratory of Social and Health Policies (LAPSS), école des Hautes études en Santé Publique (EHESP), Rennes Cedex, France
  13. établissement Fran?ais du Sang, Center de transfusion, Lariboisière University Hospital, Assistance Publique, H?pitaux de Paris, Paris Cedex 10, France
  14. Department of Anesthesiology and Critical Care Medicine, Sorbonne Paris Cité, Lariboisière Hospital, University Paris Diderot, INSERM UMR 942, Université Paris 7, 2 rue Ambroise Paré, 75010, Paris Cedex 10, France
  

文摘

Purpose Severe postpartum haemorrhage (SPPH) is the leading cause of peripartum hysterectomy and maternal death. There are no easily measurable parameters that indicate the failure of medical therapy and the need for an advanced interventional procedure (AIP) to stop genital tract bleeding. The aim of the study was to define factors predictive of the need for an AIP in the management of emergent PPH. Methods The study included two phases: (1) an initial retrospective study of 257 consecutive patients with SPPH, allowing the determination of independent predictors of AIP, which were subsequently grouped in a predictive score, followed by (2) a multicentre study of 239 patients admitted during 2007, designed to validate the score. The main outcome measure was the need for an AIP, defined as uterine artery embolization, intraabdominal packing, arterial ligation or hysterectomy. Results Abnormalities of placental implantation, prothrombin time <50% (or an International Normalized Ratio >1.64), fibrinogen <2?g/l, troponin detectable, and heart rate >115?bpm were independently predictive of the need for an AIP. The SPPH score included each of the five predictive factors with a value of 0 or 1. The greater the SPPH score, the greater the percentage of patients needing an AIP (11% for SPPH 0, to 75% for SPPH ?). The AUC of the ROC curve of the SPPH score was 0.80. Conclusions We identified five independent predictors of the need for an AIP in patients with SPPH and persistent bleeding. Using these predictors in a single score could be a reliable screening tool in patients at risk of persistent genital tract bleeding and needing an AIP.