Nov
2019

Association of timing of plasma transfusion with adverse maternal outcomes in women with persistent postpartum hemorrhage.

Henriquez D, Caram-Deelder C, le Cessie S, et al.
JAMA Netw Open 2019;2:e1915628.
NATA Rating :
Review by : B. J. Hunt
NATA Review

Early plasma transfusion is believed to improve maternal outcomes in postpartum haemorrhage (PPH) because it could theoretically  prevent or treat coagulopathy occurring among women treated for persistent PPH. However, as with other areas of PPH, studies evaluating the effect of plasma transfusion on outcomes of women with severe PPH are scarce.

This study is an impressive approach to using retrospective data on plasma transfusion in women with persistent PPH. It is a multicentre, time-dependent propensity score-matched cohort study of women with persistent PPH, empirical, early plasma transfusion was not associated with better maternal outcomes (as measured by a composite that included death, hysterectomy and embolisation)  compared with women who received no or later plasma transfusion. Similar results were observed in all sensitivity analyses.

Of course, observational studies on the serial changes in  levels of coagulation factors in women with PPH would be helpful; but ultimately prospective clinical trials of early vs. late plasma are required to answer the question as to whether early plasma is needed. Nonetheless, this study gives valuable interim data suggesting that early plasma is not a necessity in women with persistent PPH in high-income countries.

– Beverley J. Hunt

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