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Smit Sibinga CT. Has the knowledge economy a role to play in transfusion medicine? Transfus Apher Sci 2024; 63:103892. [PMID: 38365526 DOI: 10.1016/j.transci.2024.103892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
The history of blood transfusion has been dominated by the search for compatibility for species specificity, the search for how to transfer blood from one individual into another or infuse. Safety has become a major issue since it became clear that blood was not only able to allow mystical miracles to take place but could transmit infectious diseases. The science behind these ideas reflects observation, a thinking and exchange of knowledge and skills, originally documented in reports or case studies of what has happened and was observed, and peer presented - knowledge economy.
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Bermúdez-Forero MI, Delgado-López DC, Anzola-Samudio DA, Palomino F, Garcia-Otalora MA. Role of disruptions in O RhD negative donations in Colombia on increasing maternal mortality ratio from haemorrhage. Transfus Med 2024; 34:142-153. [PMID: 38151257 DOI: 10.1111/tme.13021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/30/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE The aim of this work was to evaluate the relationship of the maternal mortality ratio due to obstetric haemorrhage (MMROH) with the national blood donations, particularly O RhD negative (Oneg) before and during COVID-19 pandemic. BACKGROUND The maternal mortality ratio is increasing in Colombia, yet little is known regarding the relationship between blood donations and maternal mortality due to obstetric haemorrhage. MATERIALS AND METHODS A retrospective cross-sectional study between January 1, 2018, and December 31, 2021, was performed, to assess MMROH compared to the blood donations notified to the Colombian National Haemovigilance System, through non-parametric methods. Because a relationship between blood donations and MMROH was identified, the analysis was expanded from 2009 to 2017. RESULTS In 2020, Colombia increased the MMROH by 32% compared to 2019 which coincided with the lockdown period to contain COVID-19. An inversed relationship (SumD2 = 631.0; rs = -0.7335; p 0.01) between blood donations, particularly Oneg (SumD2 = 652.0; rs = -0.7912; p 0.002) and MMROH was identified. For the years 2015-2019 and 2021, the annual mean MMROH was 8.5 ± 0.5 per 100 000 live births when the annual mean blood donations was 18.2 ± 0.4 donations per 1000 people and the Oneg was 1.0 ± 0.0 donations per 1000 people. In contrast, the years 2009-2014 and 2020 displayed an annual MMROH of 12.6 ± 0.8, when the annual collection of blood was 16.4 ± 0.8 donations and the Oneg was 0.9 ± 0.0, p < 0.001. CONCLUSION There was an inverse relationship between blood donation, mainly Oneg, and maternal mortality from obstetric haemorrhage. However, we recognise these deaths could be related to other reasons, especially when they occurred in rural areas with limited access to medical services.
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Affiliation(s)
- María-Isabel Bermúdez-Forero
- Coordinación Red Nacional Bancos de Sangre y Servicios de Transfusión, Instituto Nacional de Salud (INS), Bogotá, Colombia
| | | | - Diego-Alexander Anzola-Samudio
- Coordinación Red Nacional Bancos de Sangre y Servicios de Transfusión, Instituto Nacional de Salud (INS), Bogotá, Colombia
| | - Fernando Palomino
- Fundación para Alternativas a la Transfusión Sanguínea (FUATS), Bogotá, Colombia
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Kowalczyk JJ, Cecconi M, Butwick AJ. Evaluating tranexamic acid for the prevention and treatment of obstetric hemorrhage. Curr Opin Obstet Gynecol 2024; 36:88-96. [PMID: 38170626 DOI: 10.1097/gco.0000000000000935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Tranexamic acid (TXA) has emerged as a promising pharmacological adjunct to treat and prevent postpartum hemorrhage (PPH). We provide an overview of TXA, including its pharmacology, key findings of randomized trials and observational studies, and critical patient safety information. RECENT FINDINGS Pharmacokinetic data indicate that TXA infusions result in peak plasma concentration within 3 min (range: 1-6.6 min). Ex-vivo pharmacodynamic data suggest that low-dose TXA (5 mg/kg) inhibits maximum lysis for at least 1 h. In predominantly developing countries, TXA has demonstrated a 19% reduction in the risk of bleeding-related death among patients with PPH. Based on high-quality randomized trials, TXA prophylaxis does not effectively reduce the risk of PPH during vaginal delivery and is likely ineffective in reducing the PPH risk during cesarean delivery. TXA exposure does not increase the risk of maternal thrombotic events. Maternal deaths have occurred from accidental intrathecal TXA injection from look-alike medication errors. SUMMARY TXA has shown promise as an important adjunct for PPH treatment, especially in low-resource settings. However, TXA is not recommended as PPH prophylaxis during vaginal or cesarean delivery. Patient safety initiatives should be prioritized to prevent maternal death from accidental intrathecal TXA injection.
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Affiliation(s)
- John J Kowalczyk
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maurizio Cecconi
- Biomedical Sciences Department, Humanitas University
- Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alexander J Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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VanderMeulen H, Tang GH, Sholzberg M. Tranexamic acid for management of heavy vaginal bleeding: barriers to access and myths surrounding its use. Res Pract Thromb Haemost 2024; 8:102389. [PMID: 38623473 PMCID: PMC11017359 DOI: 10.1016/j.rpth.2024.102389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 04/17/2024] Open
Abstract
Tranexamic acid is safe and effective for the treatment of heavy vaginal bleeding during menstruation and childbirth. It improves the quality of life, facilitates participation in school and work, and reduces the risk of death from postpartum hemorrhage. Despite its well-established benefits, individual- and structural-level barriers preclude its widespread utilization, hindering effective patient care and perpetuating health inequities in women's health. We first describe the evidence for the use of tranexamic acid in treating heavy menstrual bleeding and postpartum hemorrhage. Barriers to tranexamic acid use, including structural sexism, period poverty, misinformation in product monograph labeling, stigmatization of vaginal blood loss, and drug access, are then discussed. Finally, we summarize relevant data presented during the 2023 International Society on Thrombosis and Haemostasis Congress.
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Affiliation(s)
- Heather VanderMeulen
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Grace H. Tang
- Department of Hematology, Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle Sholzberg
- Department of Medicine and Laboratory Medicine & Pathobiology, St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
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Etemady M, Hajizadeh M, Gidaszewski B, Swain JA, Chua SC, Khajehei M. Use of iron in perinatal anaemia: Indications for women’s health care policies and procedure. World J Obstet Gynecol 2023; 12:33-44. [DOI: 10.5317/wjog.v12.i4.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/04/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023] Open
Abstract
This paper reviews management of obstetric anaemia and the role of intravenous iron for the treatment of obstetric anaemia. Red blood cell transfusions are routinely used for haemoglobin restoration in anaemic women. The decision for red blood cell transfusion is made on a combination of haemoglobin level and clinical status, and it is suggested that transfusions are not necessary in those who are well compensated or when alternative therapy is available. To reduce the risk, intravenous iron infusion is proposed as a bloodless therapeutic approach. There are a variety of iron preparations. Intravenous iron infusion can reduce the requirement for blood transfusion in hemodynamically stable women with perinatal anaemia, especially in resource-scarce settings. It a cost-effective bloodless approach for the treatment of anaemia than can enhance patient outcomes. According to the literature, when haemoglobin is greater than 90 g/L, blood transfusion is not often required. In perinatal women with anaemia, the decision whether to administer blood or iron is based on patient preferences, haemoglobin levels, clinical symptoms, past and present medical conditions and the clinician’s judgement. Nevertheless, due to the lack of rigid criteria for blood transfusions in the majority of clinical settings, it is considered the default treatment for anaemia in perinatal women.
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Affiliation(s)
- Mike Etemady
- School of Health Sciences, University of Sydney, Sydney, Australia, Sydney 2000, NSW, Australia
| | - Melika Hajizadeh
- Stotts College, Acknowledge Education, Sydney 2000, NSW, Australia
| | - Beata Gidaszewski
- Department of Women’s and Newborn Health, Westmead Hospital, Westmead 2145, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney 2000, NSW, Australia
| | - Julie Ann Swain
- Women's and Newborn Health, Westmead hospital, Westmead 2145, NSW, Australia
| | - Seng Chai Chua
- Department of Women’s and Newborn Health, Westmead Hospital, Westmead 2145, NSW, Australia
- Clinical School, Western Sydney University, Sydney 2145, NSW, Australia
| | - Marjan Khajehei
- Department of Women’s and Newborn Health, Westmead Hospital, Westmead 2145, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney 2000, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney 2145, NSW, Australia
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Ghose I, Wiley RL, Ciomperlik HN, Chen HY, Sibai BM, Chauhan SP, Mendez-Figueroa H. Association of adverse outcomes with three-tiered risk assessment tool for obstetrical hemorrhage. Am J Obstet Gynecol MFM 2023; 5:101106. [PMID: 37524259 DOI: 10.1016/j.ajogmf.2023.101106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/23/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Guidelines promote stratification for the risk for postpartum hemorrhage among parturients, although the evidence for the associated differential morbidity among the groups remains inconsistent among published reports. OBJECTIVE Using the California Maternal Quality Care Collaborative schema modified by the American College of Obstetrics and Gynecology, we compared the composite maternal hemorrhagic outcome and the composite neonatal adverse outcome among singletons who were categorized after delivery by the researchers as low-, medium-, or high-risk for postpartum hemorrhage. We hypothesized that the composite outcomes would be significantly different among the individuals in the different 3-tiered categories. STUDY DESIGN This was a retrospective cohort study of all singleton parturients with a gestational age of at least 14 weeks who delivered at a single site within 1 year. The composite maternal hemorrhagic outcome included any of the following: estimated blood loss ≥1000 mL, use of uterotonics (excluding prophylactic oxytocin) or Bakri balloon, surgical management of postpartum hemorrhage, blood transfusion, hysterectomy, thromboembolism, admission to the intensive care unit, or maternal death. The composite neonatal adverse outcome included Apgar score <7 at 5 minutes, birth injury, bronchopulmonary dysplasia, intraventricular hemorrhage, neonatal seizure, sepsis, ventilation > 6 hrs., brachial plexus palsy, hypoxic-ischemic encephalopathy, or neonatal death. Multivariable Poisson regression models with robust error variance were used to estimate the adjusted relative risks with 95% confidence intervals. RESULTS Of the 4544 deliveries in the study period, 4404 (96.7%) met the inclusion criteria, and among them, 1745 (39.6%) were categorized as low, 1376 (31.2%) as medium, and 1283 (29.1%) as high risk. Overall, 941 (21.4%) participants experienced the composite maternal hemorrhagic outcome with 285 (16.4%) of those being in the low-risk group, 319 (23.2%) in the medium-risk group, and 337 (26.3%) in the high-risk group. Among all parturients, 95.7% in the low-, 89.4% in the medium-, and 85.3% in the high-risk group neither had an estimated blood loss or a quantified blood loss ≥1000 mL nor were transfused. After multivariable adjustment and when compared with the low-risk group, there was a significantly higher risk for the composite maternal hemorrhagic outcome in the medium-risk group (adjusted relative risk, 1.23; 95% confidence interval, 1.05-1.43) and in the high-risk group (adjusted relative risk, 1.51; 95% confidence interval, 1.31-1.75). Overall, 366 newborns (8.4%) developed the composite neonatal adverse outcome with 76 (4.2%) in of those being in the low-risk group, 153 (11.3%) in the medium-risk group, and 140 (11.1%) in the high-risk group. After multivariable adjustment and when compared with the low-risk group, there were no significant differences in the composite neonatal adverse outcome in the medium- (adjusted relative risk, 1.27; 95% confidence interval, 0.97-1.68) or the high-risk group (adjusted relative risk, 1.29; 95% confidence interval, 0.98-1.68). CONCLUSION Although 8 of 10 parturients categorized as high risk neither had blood loss ≥1000 mL nor underwent transfusion, the risk stratification provides information regarding the composite maternal hemorrhagic outcome.
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Affiliation(s)
- Ipsita Ghose
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Rachel L Wiley
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Hailie N Ciomperlik
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Han-Yang Chen
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Baha M Sibai
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX.
| | - Hector Mendez-Figueroa
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
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Gruneberg D, Braun P, Schöchl H, Nachtigall-Schmitt T, von der Forst M, Tourelle K, Dietrich M, Wallwiener M, Wallwiener S, Weigand MA, Fluhr H, Spratte J, Hofer S, Schmitt FCF. Fibrinolytic potential as a risk factor for postpartum hemorrhage. Front Med (Lausanne) 2023; 10:1208103. [PMID: 37746089 PMCID: PMC10516290 DOI: 10.3389/fmed.2023.1208103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/27/2023] [Indexed: 09/26/2023] Open
Abstract
Background Postpartum hemorrhage (PPH) is still the leading cause of maternal morbidity and mortality worldwide. While impaired fibrin polymerization plays a crucial role in the development and progress of PPH, recent approaches using viscoelastic measurements have failed to sensitively detect early changes in fibrinolysis in PPH. This study aimed to evaluate whether women experiencing PPH show alterations in POC-VET fibrinolytic potential during childbirth and whether fibrinolytic potential offers benefits in the prediction and treatment of PPH. Methods Blood samples were collected at three different timepoints: T0 = hospital admission (19 h ± 18 h prepartum), T1 = 30-60 min after placental separation, and T2 = first day postpartum (19 h ± 6 h postpartum). In addition to standard laboratory tests, whole-blood impedance aggregometry (Multiplate) and viscoelastic testing (VET) were performed using the ClotPro system, which included the TPA-test lysis time, to assess the POC-VET fibrinolytic potential, and selected coagulation factors were measured. The results were correlated with blood loss and clinical outcome markers. Severe PPH was defined as a hemoglobin drop > 4g/dl and/or the occurrence of shock or the need for red blood cell transfusion. Results Blood samples of 217 parturient women were analyzed between June 2020 and December 2020 at Heidelberg University Women's Hospital, and 206 measurements were eligible for the final analysis. Women experiencing severe PPH showed increased fibrinolytic potential already at the time of hospital admission. When compared to non-PPH, the difference persisted 30-60 min after placental separation. A higher fibrinolytic potential was accompanied by a greater drop in fibrinogen and higher d-dimer values after placental separation. While 70% of women experiencing severe PPH showed fibrinolytic potential, 54% of those without PPH showed increased fibrinolytic potential as well. Conclusion We were able to show that antepartal and peripartal fibrinolytic potential was elevated in women experiencing severe PPH. However, several women showed high fibrinolytic potential but lacked clinical signs of PPH. The findings indicate that high fibrinolytic potential is a risk factor for the development of coagulopathy, but further conditions are required to cause PPH.
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Affiliation(s)
- Daniel Gruneberg
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Paula Braun
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Herbert Schöchl
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with Allgemeine Unfallversicherungsanstalt, Vienna, Austria
| | | | - Maik von der Forst
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kevin Tourelle
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Maximilian Dietrich
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Stephanie Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Markus A. Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Herbert Fluhr
- Division of Obstetrics, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Julia Spratte
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Stefan Hofer
- Department of Anesthesiology, Kaiserslautern Westpfalz Hospital, Kaiserslautern, Germany
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Bouthors AS, Gilliot S, Sentilhes L, Hennart B, Jeanpierre E, Deneux-Tharaux C, Lebuffe G, Odou P. The role of tranexamic acid in the management of postpartum haemorrhage. Best Pract Res Clin Anaesthesiol 2022; 36:411-426. [PMID: 36513435 DOI: 10.1016/j.bpa.2022.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022]
Abstract
In the last decades, tranexamic acid (TXA) has emerged as an essential tool in blood loss management in obstetrics. TXA prophylaxis for postpartum haemorrhage (PPH) has been studied in double-blind, placebo-controlled, randomized clinical trials (RCTs). Given the small observed preventive effect, the systematic use of TXA for vaginal and/or caesarean deliveries remains controversial. The result of a pharmacokinetic modelling suggests that relative to intravenous administration, intramuscular administration may be an equally effective alternative route for preventing PPH and may enable access to this drug in low-resource countries. Prophylaxis is currently studied in high-risk populations, such as women with prepartum anaemia or placenta previa. TXA effectively reduces blood loss and PPH-related morbidity and mortality during active PPH, as demonstrated by high-grade evidence from large RCTs. The drug has a good safety profile: in most cases, only mild gastrointestinal or visual adverse events may be observed. TXA use does not increase the risk of serious adverse events, such as venous or arterial thromboembolism, seizures, or acute kidney injury. The TRACES in vivo analysis of biomarkers of TXA's antifibrinolytic effect have suggested that a dose of at least 1 g is required for the treatment of PPH. The TRACES pharmacokinetic model suggests that because TXA can be lost in the haemorrhaged blood, a second dose should be administered if the PPH continues or if severe coagulopathy occurs. Future pharmacodynamic analyses will focus on the appropriateness of TXA dosing regimens with regard to the intensity of fibrinolysis in catastrophic obstetric events.
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Affiliation(s)
- Anne-Sophie Bouthors
- Anaesthesia Intensive Care Unit, Jeanne de Flandre Women's Hospital, Lille University Medical Centre, F-59037, Lille, France; Univ. Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France.
| | - Sixtine Gilliot
- Univ. Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France; Central Pharmacy, Lille University Medical Centre, F-59037, Lille, France.
| | - Loïc Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, F-33076 Bordeaux, France
| | - Benjamin Hennart
- Toxicology Unit, Biology and Pathology Centre, Lille University Medical Centre, F-59037, Lille, France
| | - Emmanuelle Jeanpierre
- Haemostasis Unit, Biology and Pathology Centre, Lille University Medical Centre, F-59037, Lille, France
| | - Catherine Deneux-Tharaux
- Université Paris Cité, CRESS UMR 1153, Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, F75014 Paris, France
| | - Gilles Lebuffe
- Univ. Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France; Anaesthesia and Intensive Care Unit, Lille University Medical Centre, F-59037 Lille, France
| | - Pascal Odou
- Univ. Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France; Central Pharmacy, Lille University Medical Centre, F-59037, Lille, France
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The management of peri-operative anaemia in patients undergoing major abdominal surgery in Australia and New Zealand: a prospective cohort study. Med J Aust 2022; 217:487-493. [PMID: 36134647 PMCID: PMC9825983 DOI: 10.5694/mja2.51725] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To assess the prevalence and management of anaemia in patients undergoing major abdominal surgery, and the influence of guideline adherence on patient outcomes. DESIGN Prospective observational cohort study. SETTING 56 hospitals in Australia and New Zealand. PARTICIPANTS People aged 18 years or more who underwent major abdominal surgery during two 2-week periods in July 2021. MAIN OUTCOME MEASURES Proportions of patients managed according to Australian National Blood Authority patient blood management guidelines. SECONDARY OUTCOMES anaemia prevalence, post-operative complications, length of hospital stay, re-admission within 30 days of discharge. RESULTS Data were available for 2730 eligible patients (mean age, 56.7 years; SD, 17.3 years), including 1558 women (57.1%). Haemoglobin levels prior to surgery were documented for 2461 of 2727 patients (90.2%), 689 of whom had anaemia (28.0%). Pre-operative anaemia assessment and management were associated with lower likelihood of intra-operative (adjusted odds ratio [aOR], 0.33; 95% CI, 0.19-0.57) and post-operative blood transfusion (aOR, 0.36; 95% CI, 0.25-0.53), and of post-operative complications (aOR, 0.79; 95% CI, 0.63-0.99). Tranexamic acid was administered during 128 of 2728 procedures (4.7%); a restrictive transfusion strategy was followed for 96 of the 167 patients who received post-operative blood transfusions (58%). Post-operative anaemia was identified in 1227 of 2069 patients (59.3%) in whom haemoglobin was assessed prior to discharge. The proportion of people re-admitted to hospital within 30 days was larger for patients with anaemia at discharge (169 of 1207 patients followed up, 14.0% v 61 of 825, 7.4%). Haemoglobin assessments were recorded by 30 days after discharge for only 288 patients with post-operative anaemia (24.3%). CONCLUSIONS The management of peri-operative anaemia differs between hospitals in Australia and New Zealand, with consequences for patient outcomes. Patients are often discharged after surgery with anaemia, which is therefore a potential therapeutic target. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12621001517864 (retrospective).
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Midwives' experiences of reducing maternal morbidity and mortality from postpartum haemorrhage (PPH) in Eastern Nigeria. BMC Pregnancy Childbirth 2022; 22:474. [PMID: 35676645 PMCID: PMC9175340 DOI: 10.1186/s12884-022-04804-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Postpartum haemorrhage (PPH) is one of the major complications of childbirth which may result in maternal morbidity and mortality, especially in low and middle-income countries like Nigeria. Midwives play a vital role in preventing and managing PPH in Nigerian rural communities. The aim of this study is to understand the experiences of midwives in rural maternity care settings in order to provide appropriate support and improve practice. Methods An exploratory, qualitative study of a purposive sample of 15 practicing midwives was carried out using semi-structured interviews from November 2018 to February 2019. Data were transcribed verbatim and analyzed using content analysis. Results Four themes were identified: 1. interventions for preventing PPH; 2. approaches to managing PPH; 3. challenges of preventing and managing PPH and 4. ways of supporting midwives to overcome these challenges in rural health care settings. Midwives employed various strategies, such as antenatal education, diagnosis and treatment of anaemia to counteract complications from possible PPH. Understanding PPH as a life-threatening condition enabled the midwives to provide holistic and effective management that sometimes involved a multidisciplinary team approach. Inadequate resources and delay in seeking health care, however, militate against their efforts. The midwives also identified the need for continuing education and training to enhance their standards of care. Conclusion These midwives in Nigerian rural health care settings engage in preventive practices and active management of PPH though not without barriers, such as inadequate resources. There is a need for midwives in rural areas to have cultural competence, be provided with adequate resources and participate in ongoing education in order to be more effective. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04804-x.
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Ahmad N, Ramlan N, Ganeshan M, Bhaskaran KS, Ismail F, Razak T, Hassan A, Amin N. Massive transfusion protocol for postpartum hemorrhage case management in Hospital Kuala Lumpur; Five years implementation and outcome. Asian J Transfus Sci 2022. [DOI: 10.4103/ajts.ajts_102_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Aziz S, Rossiter S, Homer CSE, Wilson AN, Comrie‐Thomson L, Scott N, Vogel JP. The cost-effectiveness of tranexamic acid for treatment of postpartum hemorrhage: A systematic review. Int J Gynaecol Obstet 2021; 155:331-344. [PMID: 33621351 PMCID: PMC8596845 DOI: 10.1002/ijgo.13654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/02/2021] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is responsible for nearly one quarter of maternal deaths. A 2017 multicountry trial found that incorporating tranexamic acid (TXA) into the PPH management package was effective in reducing maternal death due to bleeding. OBJECTIVE To systematically review studies assessing the cost-effectiveness of tranexamic acid for PPH treatment. SEARCH STRATEGY Nine databases were searched using variations of keywords 'tranexamic acid', 'postpartum hemorrhage' and 'cost effectiveness'. SELECTION CRITERIA Eligible studies were any type of economic or effectiveness evaluation studies on tranexamic acid for treating women with PPH. DATA COLLECTION AND ANALYSIS Two reviewers independently screened citations and extracted data on cost effectiveness measures. Quality was assessed using the Consensus on Health Economic Criteria list. MAIN RESULTS Four studies were included, of which two were abstracts. Three studies concluded that early administration of TXA was cost-saving or cost-effective. One abstract reported TXA was not cost-effective in the USA unless the probability of death due to hemorrhage is higher. CONCLUSION Available evidence (four studies in three countries) suggests that this life-saving intervention may be below willingness to pay thresholds (cost-effective) or cost saving. Further studies conducted in different populations and settings are needed to inform health policy decision-making to reduce PPH-associated morbidity and mortality.
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Affiliation(s)
- Samia Aziz
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVic.Australia
- School of Population and Global HealthThe University of MelbourneMelbourneVic.Australia
| | - Shania Rossiter
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVic.Australia
- School of Population and Global HealthThe University of MelbourneMelbourneVic.Australia
| | - Caroline S. E. Homer
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVic.Australia
| | - Alyce N. Wilson
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVic.Australia
- Nossal Institute for Global HealthMelbourne School of Population and Global HealthUniversity of MelbourneMelbourneVic.Australia
| | - Liz Comrie‐Thomson
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVic.Australia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVic.Australia
- Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
| | - Nick Scott
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVic.Australia
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health ProgramBurnet InstituteMelbourneVic.Australia
- Nossal Institute for Global HealthMelbourne School of Population and Global HealthUniversity of MelbourneMelbourneVic.Australia
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13
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Abstract
Obstetric hemorrhage is a leading cause of morbidity and mortality. Prevention includes identifying patients with risk factors and actively managing the third stage of labor. The anesthesiologist should be ready to manage hemorrhage with general strategies as well as strategies tailored to the specific cause of hemorrhage. Both neuraxial anesthesia and general anesthesia are appropriate in different situations. Treatments proven to be effective include increasing the oxytocin infusion, administering tranexamic acid early, guiding transfusion with point-of-care tests, and using cell salvage. Utilization of protocols and checklists within systems that encourage effective communication between teams should be implemented.
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Affiliation(s)
- Sarah Kroh
- Obstetric Anesthesiology, UPMC Magee Women's Hospital, University of Pittsburgh Medical School, 300 Halket Street, Pittsburgh, PA 15213, USA.
| | - Jonathan H Waters
- Anesthesiology & Perioperative Medicine, UPMC Magee-Womens Hospital, Patient Blood Management Program, 300 Halket Street, Pittsburgh, PA 15213, USA
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14
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Zafar S, Tayyab F, Liaqat A, Sikander S, Hollins Martin CJ, Martin CR. Translation and Validation of the Birth Satisfaction Scale-Revised in Urdu for Use in Pakistan. INTERNATIONAL JOURNAL OF CHILDBIRTH 2021. [DOI: 10.1891/ijcbirth-d-21-00001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDSatisfaction with the birth experience is increasingly recognized as critical to the well-being of mother and baby and thus accurate assessment of this key dimension is essential. The Birth Satisfaction Scale-Revised (BSS-R) has been shown to be a robust, valid, and reliable measure of birth experience. The current study sought to develop an Urdu version of the measure to be used in Pakistan.METHODSFollowing translation, a cross-sectional design was used to examine the measurement properties of the Pakistan (Urdu)-BSS-R (P-BSS-R). Participants were a purposive sample of Pakistani postnatal women (n = 200). Key psychometric properties were examined using Confirmatory Factor Analysis (CFA), internal consistency evaluation, and known-groups discriminant validity testing.RESULTSThe majority of measurement parameters for clinical application of the P-BSS-R were found to be acceptable with good known-groups discriminant validity and data fit to the tri-dimensional theoretical model of the BSS-R observed. However, some idiosyncratic observations were highlighted, including unexpected low internal consistency.CONCLUSIONSThe P-BSS-R was found to be a generally valid and reliable measure of the experience, a caveat being low internal consistency warranting further investigation.
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