Background and Goal of Study: Recent knowledge suggests the pivotal role of fibrinogen and fibrinolysis in the severity in PPH. Our local protocol implemented the use of fibrinogen and antifibrinolytics (Tranexamic acic) as a second step after the use of sulprostone and before uterine embolization in the therapeutic algorithm.
The aim of this study was to evaluate the effect of this new protocol [2009-2011 period] on blood products transfusion as compared to the [2000-2004 period] when uterine artery embolization was introduced.
Materials and Methods: This retrospective case-study collected data from computer files of patients.Severe PPH was defined as blood transfusion ≥4 units or uterine artery embolization or hysterectomy. Coagulopathy was defined by PT< 50% or APTT> 1.5 or platelet count < 100 G/L or + dDimers or fibrinogène < 2g/L, Data between the 2 periods were compared by exact Fischer tests or ANOVA; results are expressed as mean ± Se with a p< 0.05 as statistical threshold.
Results and Discussion: The incidence of PPH increased from 2.12% (183/8664) to 3.47% (289/8318), p< 0.01 and severe forms were reduced from 32.3% to 26,0% of PPH (p = 0.02). Among women requiring transfusion, red blood cell units transfusion decreased from 5.17 ± 4.48 U to 3.58 ± 2.69 U (p< 0.01). Coagulopathy was observed in less PPH (31.0% and 26.3%of PPH, p< 0.01). calculated blood loss In transfused patients decreased from 4435 ± 2402 mL to 3359 ± 1590 mL (p< 0.01).
Fresh frozen plasma and platelet transfusion did not vary (not shown) Sulprostone use was increased (49.2% vs 54.0% of PPH, p< 0.01). ) as was those of fibrinogen concentrates (7.1% 30,45% of PPH, p< 0.01) and Tranexamic acid (0% to 21.8% of PPH, p< 0.01). Uterine embolization was necessary in respectively 40 (21.9%) and 60 (20.75%) cases then Hysterectomy in respectively 4 and 2 women.
This therapeutic algorithm led to an increased sulprostone, tranexamic acid and fibrinogen administration but less severe PPH and erythrocytes concentrates use. The absence of effect on fresh frozen plasma use may be explained by clinical habit to order immediately this blood product.
Conclusion(s): This retrospective study adds a new milestone on the potential role of fibrinolysis and fibrinogen in the severity of PPH.