Skip to main content
SpringerLink
Log in

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

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. World Health Organization (2009) WHO guidelines for the management of postpartum haemorrhage and retained placenta. WHO Press, Geneva. ISBN 978-92-4-159851-4

    Google Scholar 

  2. Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF (2006) WHO analysis of causes of maternal death: a systematic review. Lancet 367:1066–1074

    Article  PubMed  Google Scholar 

  3. Potts M, Hemmerling A (2006) The worldwide burden of postpartum haemorrhage: policy development where inaction is lethal. Int J Gynaecol Obstet 94(Suppl 2):S116–S121

    Article  PubMed  Google Scholar 

  4. Knight M; UKOSS (2007) Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage. BJOG 114:1380–1387

    Article  PubMed  CAS  Google Scholar 

  5. Subtil D, Somme A, Ardiet E, Depret-Mosser S (2004) Postpartum hemorrhage: frequency, consequences in terms of health status, and risk factors before delivery. J Gynecol Obstet Biol Reprod (Paris) 33:4S9–4S16

    CAS  Google Scholar 

  6. Goffinet F, Mercier F, Teyssier V, Pierre F, Dreyfus M, Mignon A, Carbonne B, Levy G (2005) Postpartum haemorrhage: recommendations for clinical practice by the CNGOF (December 2004). Gynecol Obstet Fertil 33:268–274

    Article  PubMed  CAS  Google Scholar 

  7. Prasertcharoensuk W, Swadpanich U, Lumbiganon P (2000) Accuracy of the blood loss estimation in the third stage of labor. Int J Gynaecol Obstet 71:69–70

    Article  PubMed  CAS  Google Scholar 

  8. Karpati PC, Rossignol M, Pirot M, Cholley B, Vicaut E, Henry P, Kevorkian JP, Schurando P, Peynet J, Jacob D, Payen D, Mebazaa A (2004) High incidence of myocardial ischemia during postpartum hemorrhage. Anesthesiology 100:30–36

    Article  PubMed  Google Scholar 

  9. Gulmezoglu AM, Villar J, Ngoc NT, Piaggio G, Carroli G, Adetoro L, Abdel-Aleem H, Cheng L, Hofmeyr G, Lumbiganon P, Unger C, Prendiville W, Pinol A, Elbourne D, El-Refaey H, Schulz K (2001) WHO multicentre randomised trial of misoprostol in the management of the third stage of labour. Lancet 358:689–695

    Article  PubMed  CAS  Google Scholar 

  10. Winter C, Macfarlane A, Deneux-Tharaux C, Zhang WH, Alexander S, Brocklehurst P, Bouvier-Colle MH, Prendiville W, Cararach V, van Roosmalen J, Berbik I, Klein M, Ayres-de-Campos D, Erkkola R, Chiechi LM, Langhoff-Roos J, Stray-Pedersen B, Troeger C (2007) Variations in policies for management of the third stage of labour and the immediate management of postpartum haemorrhage in Europe. BJOG 114:845–854

    Article  PubMed  CAS  Google Scholar 

  11. American Society of Anesthesiologists Task Force on Obstetrical Anesthesia (1999) Practice guidelines for obstetrical anesthesia: a report by the American Society of Anesthesiologists Task Force on Obstetrical Anesthesia. Anesthesiology 90:600–611

    Article  Google Scholar 

  12. American Society of Anesthesiologists Task Force on Obstetric Anesthesia (2007) Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology 106:843–863

    Google Scholar 

  13. Ahonen J, Stefanovic V, Lassila R (2010) Management of post-partum haemorrhage. Acta Anaesthesiol Scand 54:1164–1178

    Article  PubMed  CAS  Google Scholar 

  14. Driessen M, Bouvier-Colle MH, Dupont C, Khoshnood B, Rudigoz RC, Deneux-Tharaux C (2011) Postpartum hemorrhage resulting from uterine atony after vaginal delivery: factors associated with severity. Obstet Gynecol 117:21–31

    Article  PubMed  Google Scholar 

  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 116:1325–1333

    Article  PubMed  CAS  Google Scholar 

  16. Gissler M, Deneux-Tharaux C, Alexander S, Berg CJ, Bouvier-Colle MH, Harper M, Nannini A, Breart G, Buekens P (2007) Pregnancy-related deaths in four regions of Europe and the United States in 1999–2000: characterisation of unreported deaths. Eur J Obstet Gynecol Reprod Biol 133:179–185

    Article  PubMed  Google Scholar 

  17. Deneux-Tharaux C, Carmona E, Bouvier-Colle MH, Breart G (2006) Postpartum maternal mortality and cesarean delivery. Obstet Gynecol 108:541–548

    Article  PubMed  Google Scholar 

  18. Bouvier-Colle MH, Pequignot F, Jougla E (2001) Maternal mortality in France: frequency, trends and causes. J Gynecol Obstet Biol Reprod (Paris) 30:768–775

    CAS  Google Scholar 

  19. Bouvier-Colle MH, Salanave B, Ancel PY, Varnoux N, Fernandez H, Papiernik E, Breart G, Benhamou D, Boutroy P, Caillier I, Dumoulin M, Fournet P, Elhassani M, Puech F, Poutot C (1996) Obstetric patients treated in intensive care units and maternal mortality. Regional Teams for the Survey. Eur J Obstet Gynecol Reprod Biol 65:121–125

    Article  PubMed  CAS  Google Scholar 

  20. Bouvier-Colle MH, Varnoux N (2001) Maternal mortality and severe morbidity in 3 French regions: results of MOMS, a European multicenter investigation. J Gynecol Obstet Biol Reprod (Paris) 30:S5–S9

    CAS  Google Scholar 

  21. Bouvier-Colle MH, Varnoux N, Costes P, Hatton F (1991) Maternal mortality in France. Frequency and reasons for its under-estimation in the statistics of medical cause of death. Group of experts on maternal mortality. J Gynecol Obstet Biol Reprod (Paris) 20:885–891

    CAS  Google Scholar 

  22. Weeks A (2006) Oral misoprostol for postpartum haemorrhage. Lancet 368:2123

    Article  PubMed  Google Scholar 

  23. Charbit B, Mandelbrot L, Samain E, Baron G, Haddaoui B, Keita H, Sibony O, Mahieu-Caputo D, Hurtaud-Roux MF, Huisse MG, Denninger MH, de Prost D (2007) The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost 5:266–273

    Article  PubMed  CAS  Google Scholar 

  24. Padmanabhan A, Schwartz J, Spitalnik SL (2009) Transfusion therapy in postpartum hemorrhage. Semin Perinatol 33:124–127

    Article  PubMed  Google Scholar 

  25. Vanderschueren S, De Weerdt A, Malbrain M, Vankersschaever D, Frans E, Wilmer A, Bobbaers H (2000) Thrombocytopenia and prognosis in intensive care. Crit Care Med 28:1871–1876

    Article  PubMed  CAS  Google Scholar 

  26. Van Cott EM (2009) Point-of-care testing in coagulation. Clin Lab Med 29:543–553

    Article  PubMed  Google Scholar 

  27. Lewandrowski K (2009) Point-of-care testing for cardiac markers in acute coronary syndromes and heart failure. Clin Lab Med 29:561–571

    Article  PubMed  Google Scholar 

  28. Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle MH, Ford JB, Joseph KS, Lewis G, Liston RM, Roberts CL, Oats J, Walker J (2009) Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth 9:55

    Article  PubMed  Google Scholar 

  29. Lu MC, Fridman M, Korst LM, Gregory KD, Reyes C, Hobel CJ, Chavez GF (2005) Variations in the incidence of postpartum hemorrhage across hospitals in California. Matern Child Health J 9:297–306

    Article  PubMed  Google Scholar 

  30. Waterstone M, Bewley S, Wolfe C (2001) Incidence and predictors of severe obstetric morbidity: case-control study. BMJ 322:1089–1093

    Article  PubMed  CAS  Google Scholar 

Download references

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
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthieu Resche-Rigon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Olivier Morel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthias Rossignol
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jean Mantz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Armelle Nicolas-Robin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nathalie Nathan-Denizot
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jean-Yves Lefrant
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Frédéric J. Mercier
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Emmanuel Samain
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yann Fargeaudou
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Emmanuel Barranger
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Marie-Josèphe Laisné
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Pierre-Henri Bréchat
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Dominique Luton
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Ingrid Ouanounou
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Patricia Appa Plaza
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Claire Broche
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Didier Payen
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Alexandre Mebazaa
    View author publications

    You can also search for this author in PubMed Google Scholar

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).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 47 kb)

Supplementary material 2 (DOC 46 kb)

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.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-011-2315-0

Keywords

Search

Navigation