Restrictive versus liberal fluid resuscitation strategy, influence on blood loss and hemostatic parameters in mild obstetric hemorrhage: An open-label randomized controlled trial. (REFILL study).

<h4>Background</h4>Evidence for optimal hemostatic resuscitation in postpartum hemorrhage (PPH) is lacking. Liberal fluid administration may result in acidosis, hypothermia and coagulopathy.<h4>Objective</h4>We hypothesize that in early PPH a restrictive fluid administration...

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Autores principales:	Pim B B Schol, Natascha M de Lange, Mallory D Woiski, Josje Langenveld, Luc J M Smits, Martine M Wassen, Yvonne M Henskens, Hubertina C J Scheepers
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/cbd3b2dc45be4f6a8fce2ac5ebbc6ebf
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spelling	oai:doaj.org-article:cbd3b2dc45be4f6a8fce2ac5ebbc6ebf2021-12-02T20:09:59ZRestrictive versus liberal fluid resuscitation strategy, influence on blood loss and hemostatic parameters in mild obstetric hemorrhage: An open-label randomized controlled trial. (REFILL study).1932-620310.1371/journal.pone.0253765https://doaj.org/article/cbd3b2dc45be4f6a8fce2ac5ebbc6ebf2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0253765https://doaj.org/toc/1932-6203<h4>Background</h4>Evidence for optimal hemostatic resuscitation in postpartum hemorrhage (PPH) is lacking. Liberal fluid administration may result in acidosis, hypothermia and coagulopathy.<h4>Objective</h4>We hypothesize that in early PPH a restrictive fluid administration results in less progression to moderate PPH.<h4>Study design</h4>In four Dutch hospitals we recruited women of 18 years and over, and more than 24 weeks pregnant. Exclusion criteria were: anticoagulant therapy, known coagulation disorders, pre-eclampsia, antenatal diagnosis of abnormally adhesive placenta, and a contraindication for liberal fluid therapy. We blindly randomized participants at 500 mL and ongoing blood loss in the third stage of labor between restrictive fluid administration (clear fluids 0.75-1.0 times the volume of blood lost) and liberal fluid administration (clear fluids 1.5-2.0 times the volume of blood lost). The primary outcome was progression to more than 1000 mL blood loss. Analyses were according to the intention-to-treat principle.<h4>Results</h4>From August 2014 till September 2019, 5190 women were informed of whom 1622 agreed to participate. A total of 252 women were randomized of which 130 were assigned to the restrictive group and 122 to the liberal group. In the restrictive management group 51 of the 130 patients (39.2%) progressed to more than 1000 mL blood loss versus 61 of the 119 patients (51.3%) in the liberal management group (difference, -12.0% [95%-CI -24.3% to 0.3%], p = 0.057). There was no difference in the need for blood transfusion, coagulation parameters, or in adverse events between the groups.<h4>Conclusions</h4>Although a restrictive fluid resuscitation in women with mild PPH could not been proven to be superior, it does not increase the need for blood transfusion, alter coagulation parameters, or cause a rise in adverse events. It can be considered as an alternative treatment option to liberal fluid resuscitation.<h4>Trial registration</h4>NTR3789.Pim B B ScholNatascha M de LangeMallory D WoiskiJosje LangenveldLuc J M SmitsMartine M WassenYvonne M HenskensHubertina C J ScheepersPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0253765 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Pim B B Schol Natascha M de Lange Mallory D Woiski Josje Langenveld Luc J M Smits Martine M Wassen Yvonne M Henskens Hubertina C J Scheepers Restrictive versus liberal fluid resuscitation strategy, influence on blood loss and hemostatic parameters in mild obstetric hemorrhage: An open-label randomized controlled trial. (REFILL study).
description	<h4>Background</h4>Evidence for optimal hemostatic resuscitation in postpartum hemorrhage (PPH) is lacking. Liberal fluid administration may result in acidosis, hypothermia and coagulopathy.<h4>Objective</h4>We hypothesize that in early PPH a restrictive fluid administration results in less progression to moderate PPH.<h4>Study design</h4>In four Dutch hospitals we recruited women of 18 years and over, and more than 24 weeks pregnant. Exclusion criteria were: anticoagulant therapy, known coagulation disorders, pre-eclampsia, antenatal diagnosis of abnormally adhesive placenta, and a contraindication for liberal fluid therapy. We blindly randomized participants at 500 mL and ongoing blood loss in the third stage of labor between restrictive fluid administration (clear fluids 0.75-1.0 times the volume of blood lost) and liberal fluid administration (clear fluids 1.5-2.0 times the volume of blood lost). The primary outcome was progression to more than 1000 mL blood loss. Analyses were according to the intention-to-treat principle.<h4>Results</h4>From August 2014 till September 2019, 5190 women were informed of whom 1622 agreed to participate. A total of 252 women were randomized of which 130 were assigned to the restrictive group and 122 to the liberal group. In the restrictive management group 51 of the 130 patients (39.2%) progressed to more than 1000 mL blood loss versus 61 of the 119 patients (51.3%) in the liberal management group (difference, -12.0% [95%-CI -24.3% to 0.3%], p = 0.057). There was no difference in the need for blood transfusion, coagulation parameters, or in adverse events between the groups.<h4>Conclusions</h4>Although a restrictive fluid resuscitation in women with mild PPH could not been proven to be superior, it does not increase the need for blood transfusion, alter coagulation parameters, or cause a rise in adverse events. It can be considered as an alternative treatment option to liberal fluid resuscitation.<h4>Trial registration</h4>NTR3789.
format	article
author	Pim B B Schol Natascha M de Lange Mallory D Woiski Josje Langenveld Luc J M Smits Martine M Wassen Yvonne M Henskens Hubertina C J Scheepers
author_facet	Pim B B Schol Natascha M de Lange Mallory D Woiski Josje Langenveld Luc J M Smits Martine M Wassen Yvonne M Henskens Hubertina C J Scheepers
author_sort	Pim B B Schol
title	Restrictive versus liberal fluid resuscitation strategy, influence on blood loss and hemostatic parameters in mild obstetric hemorrhage: An open-label randomized controlled trial. (REFILL study).
title_short	Restrictive versus liberal fluid resuscitation strategy, influence on blood loss and hemostatic parameters in mild obstetric hemorrhage: An open-label randomized controlled trial. (REFILL study).
title_full	Restrictive versus liberal fluid resuscitation strategy, influence on blood loss and hemostatic parameters in mild obstetric hemorrhage: An open-label randomized controlled trial. (REFILL study).
title_fullStr	Restrictive versus liberal fluid resuscitation strategy, influence on blood loss and hemostatic parameters in mild obstetric hemorrhage: An open-label randomized controlled trial. (REFILL study).
title_full_unstemmed	Restrictive versus liberal fluid resuscitation strategy, influence on blood loss and hemostatic parameters in mild obstetric hemorrhage: An open-label randomized controlled trial. (REFILL study).
title_sort	restrictive versus liberal fluid resuscitation strategy, influence on blood loss and hemostatic parameters in mild obstetric hemorrhage: an open-label randomized controlled trial. (refill study).
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/cbd3b2dc45be4f6a8fce2ac5ebbc6ebf
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Restrictive versus liberal fluid resuscitation strategy, influence on blood loss and hemostatic parameters in mild obstetric hemorrhage: An open-label randomized controlled trial. (REFILL study).

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