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

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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.

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Acknowledgments

E. Gayat and A. Mebazaa had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

The authors are very grateful to Annie Gouverneur, Alexandrine Ferrand and Dr. Hosni Khouadja for their exceptional contribution to this work. They also thank the nurses and the whole teams of Anaesthesia and Intensive care, Obstetric and Radiology Departments. They are grateful to Dr. Sylvie Joubert from the E.F.S (Etablissement Français du Sang) and to Didier Castiel for their help. The authors also gratefully acknowledge the SAMU (Service d’Aide Médicale Urgente) of all five departments of Ile-de-France who were able to transfer the parturient patients from the primary institutions to Lariboisière Hospital in an average of 30 minutes. Finally, the authors are grateful to Peter Karpati for editing the manuscript and to Raphaël Porcher for assisting with the statistical analysis.

Conflict of interest

None of the authors have any financial relationships to disclose concerning this work.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Mobile Care Unit, Lariboisière University Hospital, AP-HP, EA322, Paris Cedex 10, France

    Etienne Gayat, Matthias Rossignol, Marie-Josèphe Laisné, Ingrid Ouanounou, Patricia Appa Plaza, Claire Broche, Didier Payen & Alexandre Mebazaa

  2. Department of Biostatistics and Clinical Epidemiology, Saint-Louis University Hospital, AP-HP, INSERM UMR 717, Paris Cedex 10, France

    Etienne Gayat & Matthieu Resche-Rigon

  3. University Paris Diderot, Sorbonne Paris Cité, 75205, Paris, France

    Etienne Gayat, Matthieu Resche-Rigon, Jean Mantz, Emmanuel Barranger, Dominique Luton, Didier Payen & Alexandre Mebazaa

  4. Department of Obstetrics and Gynaecology, Lariboisière University Hospital, AP-HP, Paris Cedex 10, France

    Olivier Morel & Emmanuel Barranger

  5. Department of Anesthesiology and Critical Care Medicine, Mobile Care Unit, Beaujon University Hospital, AP-HP, Clichy-La Garenne, France

    Jean Mantz

  6. Department of Anesthesia and Intensive Care, Mobile Care Unit, Pitié-Salpêtrière University Hospital, AP-HP, University Paris 6, Paris Cedex 13, France

    Armelle Nicolas-Robin

  7. Department of Anesthesia and Intensive Care, Hopital Mère-enfant, Limoges, France

    Nathalie Nathan-Denizot

  8. Division Anesthésie Réanimation Douleur Urgences, Groupe Hospitalo-Universitaire Caremeau, CHU Nîmes, Nîmes, France

    Jean-Yves Lefrant

  9. Department of Anesthesiology and Critical Care Medicine, Antoine Béclère hospital, AP-HP, University Paris Sud 11, Clamart, France

    Frédéric J. Mercier

  10. Pôle d’anesthésie-réanimation chirurgicale, Center hospitalier universitaire Jean-Minjoz, Université de Franche-Comté, Besançon, France

    Emmanuel Samain

  11. Department of Radiology, Lariboisière University Hospital, AP-HP, Paris Cedex 10, France

    Yann Fargeaudou

  12. Research Laboratory of Social and Health Policies (LAPSS), École des Hautes Études en Santé Publique (EHESP), Rennes Cedex, France

    Pierre-Henri Bréchat

  13. Établissement Français du Sang, Center de transfusion, Lariboisière University Hospital, Assistance Publique, Hôpitaux de Paris, Paris Cedex 10, France

    Dominique Luton

  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

    Alexandre Mebazaa

Authors
  1. Etienne Gayat
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  2. Matthieu Resche-Rigon
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  3. Olivier Morel
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  4. Matthias Rossignol
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  5. Jean Mantz
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  6. Armelle Nicolas-Robin
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  7. Nathalie Nathan-Denizot
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  8. Jean-Yves Lefrant
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  9. Frédéric J. Mercier
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  10. Emmanuel Samain
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  11. Yann Fargeaudou
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  12. Emmanuel Barranger
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  13. Marie-Josèphe Laisné
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  14. Pierre-Henri Bréchat
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  15. Dominique Luton
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  16. Ingrid Ouanounou
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  17. Patricia Appa Plaza
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  18. Claire Broche
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  19. Didier Payen
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  20. Alexandre Mebazaa
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Corresponding author

Correspondence to Alexandre Mebazaa.

Additional information

Patent

The SPPH score has been patented by the Assistance Publique-Hôpitaux de Paris and the University Paris 7 Diderot; A.M., E.G. and M.R.-R. were the main co-inventors (Patent No. WO2010/015690 A1).

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Appendix

Appendix

The multicentre validation study investigators

Assistance Publique-Hôpitaux de Paris and Université Paris 7, 6, 11. (1) Hôpital Lariboisière (Paris): Etienne Gayat, Alexandre Mebazaa, Marie-Josèphe Laisné. (2) Hôpital Beaujon (Clichy-La Garenne): Claire Bonneville, Jean Mantz. (3) Hôpital de la Pitiè-Salpêtrière (Paris): Armelle Nicolas-Robin, Olivier Langeron. (4) Hôpital Béclère (Clamart): Frédéric Mercier, Sandrine Roger-Christoph.

Center Hospitalier Universitaire de Limoges: Nathalie Nathan-Denizot, Anne Vincelot.

Center Hospitalier Universitaire de Besançon, Université de Franche-Comté: Emmanuel Samain, Frédérique Bartholin, Gilles Blasco.

Center Hospitalier Universitaire de Nîmes: Jean-Yves Lefrant, Francoise Casano, Agnès Cuvillon.

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Gayat, E., Resche-Rigon, M., Morel, O. et al. Predictive factors of advanced interventional procedures in a multicentre severe postpartum haemorrhage study. Intensive Care Med 37, 1816–1825 (2011). https://doi.org/10.1007/s00134-011-2315-0

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