Intensive Care Medicine

, 37:1816 | Cite as

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

  • Etienne Gayat
  • Matthieu Resche-Rigon
  • Olivier Morel
  • Matthias Rossignol
  • Jean Mantz
  • Armelle Nicolas-Robin
  • Nathalie Nathan-Denizot
  • Jean-Yves Lefrant
  • Frédéric J. Mercier
  • Emmanuel Samain
  • Yann Fargeaudou
  • Emmanuel Barranger
  • Marie-Josèphe Laisné
  • Pierre-Henri Bréchat
  • Dominique Luton
  • Ingrid Ouanounou
  • Patricia Appa Plaza
  • Claire Broche
  • Didier Payen
  • Alexandre Mebazaa
Original

Abstract

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 ≥2). 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.

Keywords

Post-partum hemorrhage Hemorrhagic shock Predictive score 

Supplementary material

134_2011_2315_MOESM1_ESM.doc (47 kb)
Supplementary material 1 (DOC 47 kb)
134_2011_2315_MOESM2_ESM.doc (46 kb)
Supplementary material 2 (DOC 46 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • 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
    • 3
    • 13
  • Ingrid Ouanounou
    • 1
  • Patricia Appa Plaza
    • 1
  • Claire Broche
    • 1
  • Didier Payen
    • 1
    • 3
  • Alexandre Mebazaa
    • 1
    • 3
    • 14
  1. 1.Department of Anesthesiology and Critical Care Medicine, Mobile Care UnitLariboisière University Hospital, AP-HPParis Cedex 10France
  2. 2.Department of Biostatistics and Clinical EpidemiologySaint-Louis University Hospital, AP-HP, INSERM UMR 717Paris Cedex 10France
  3. 3.University Paris DiderotParisFrance
  4. 4.Department of Obstetrics and GynaecologyLariboisière University Hospital, AP-HPParis Cedex 10France
  5. 5.Department of Anesthesiology and Critical Care Medicine, Mobile Care UnitBeaujon University Hospital, AP-HPClichy-La GarenneFrance
  6. 6.Department of Anesthesia and Intensive Care, Mobile Care UnitPitié-Salpêtrière University Hospital, AP-HPParis Cedex 13France
  7. 7.Department of Anesthesia and Intensive CareHopital Mère-enfantLimogesFrance
  8. 8.Division Anesthésie Réanimation Douleur UrgencesGroupe Hospitalo-Universitaire Caremeau, CHU NîmesNîmesFrance
  9. 9.Department of Anesthesiology and Critical Care MedicineAntoine Béclère hospital, AP-HPClamartFrance
  10. 10.Pôle d’anesthésie-réanimation chirurgicale, Center hospitalier universitaire Jean-MinjozUniversité de Franche-ComtéBesançonFrance
  11. 11.Department of RadiologyLariboisière University Hospital, AP-HPParis Cedex 10France
  12. 12.Research Laboratory of Social and Health Policies (LAPSS)École des Hautes Études en Santé Publique (EHESP)Rennes CedexFrance
  13. 13.Établissement Français du Sang, Center de transfusionLariboisière University Hospital, Assistance Publique, Hôpitaux de ParisParis Cedex 10France
  14. 14.Department of Anesthesiology and Critical Care Medicine, Sorbonne Paris CitéLariboisière Hospital, University Paris Diderot, INSERM UMR 942Paris Cedex 10France

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