Red blood cell (RBC) transfusions are of utmost importance in the management of severe post-partum haemorrhage. Although the recommendations for blood transfusion protocols are regularly issued, there are significant differences in management depending on the context and the medical teams involved. To determine during the first 24 h, the clinical and biological factors associated with the decision for RBC transfusion during severe PPH (≥1000 mL) for vaginal and caesarean deliveries. Monocentric retrospective study conducted in a tertiary care university maternity unit (CHI-Creteil) including all parturients from November 23th 2018 to 31th December 2020 with severe PPH (≥1000 mL). Over the study period, we reported 7103 deliveries, out of which 682 were complicated by PPH (9.6 %) with 200 cases of PPH ≥1000 mL (2.8 %). In our study, 40 % of patients (80/200) required a RBC transfusion”. After multivariate analysis, severe PPH caused by placental abruption, uterine rupture or placental implantation disorders (aOR = 3.48 IC95 [1.27–9.52], < 0.001), estimated blood loss ≥1500 mL (aOR = 9.60 IC95 [3.69–24.95], < 0. 001), invasive measures such as uterine balloon tamponade, arterial ligation and uterine packing (aOR = 4.15 IC95 [1.80–9.61], < 0.001), pre-labor hemoglobin <10 g/dL (aOR =4.88 IC95 [1.57–15.15], < 0.001) or abnormal biological results in the acute phase (including hemoglobin <7.0 g/dL and/or fibrinogen <2 g/L and/or platelets <100 G/L) (aOR =356 IC95 [1,05–12,10], < 0.001) were significantly and independently associated with the decision to initiate RBC transfusions. In a monocentric retrospective study including 200 consecutive cases of severe PPH (≥1000 mL) we identified groups of clinical and biological factors directly accessible to clinicians, significantly and independently associated with RBC transfusion in the first 24 h of management.

中文翻译：

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严重产后出血期间与红细胞输注相关的临床和生物学因素——单中心回顾性队列研究

红细胞（RBC）输注对于严重产后出血的治疗至关重要。尽管输血方案的建议会定期发布，但根据具体情况和所涉及的医疗团队，管理上存在显着差异。确定在前 24 小时内，与阴道分娩和剖腹产严重 PPH（≥1000 mL）期间红细胞输注决策相关的临床和生物学因素。在三级保健大学妇产科 (CHI-Creteil) 进行的单中心回顾性研究，包括 2018 年 11 月 23 日至 2020 年 12 月 31 日期间所有患有严重 PPH（≥1000 mL）的产妇。在研究期间，我们报告了 7103 例分娩，其中 682 例并发 PPH (9.6%)，其中 200 例 PPH ≥1000 mL (2.8%)。在我们的研究中，40% 的患者 (80/200) 需要红细胞输注”。多变量分析后，胎盘早剥、子宫破裂或胎盘着床障碍引起的严重产后出血（aOR = 3.48 IC95 [1.27–9.52]，< 0.001），估计失血量≥1500 mL（aOR = 9.60 IC95 [3.69–24.95]，< 0. 001)，侵入性措施，如子宫球囊填塞、动脉结扎和子宫填塞 (aOR = 4.15 IC95 [1.80–9.61], < 0.001)，产前血红蛋白 <10 g/dL (aOR =4.88 IC95 [1.57– 15.15]，< 0.001）或急性期异常生物学结果（包括血红蛋白 <7.0 g/dL 和/或纤维蛋白原 <2 g/L 和/或血小板 <100 G/L）（aOR =356 IC95 [1,05 –12,10], < 0.001) 与开始红细胞输血的决定显着且独立相关。在一项包括 200 例连续严重 PPH（≥1000 mL）病例的单中心回顾性研究中，我们确定了临床医生可直接接触到的临床和生物学因素组，这些因素与治疗前 24 小时内红细胞输注显着且独立相关。