{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T05:52:00Z","timestamp":1791179520622,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100019031","name":"Chongqing Municipal Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2021YFC2701500"],"award-info":[{"award-number":["2021YFC2701500"]}],"id":[{"id":"10.13039\/501100019031","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the pattern of massive obstetrical transfusion in China and its effect on severe maternal morbidity (SMM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This nationwide retrospective cohort study enrolled all women with a pregnancy of more than 14\u2009weeks duration who received at least 4\u2009units of packed red blood cells (PRBCs) within 24\u2009h after delivery in 64 tertiary hospitals in China from January 1, 2009, to June 30, 2019. Multivariate log\u2010binomial regression models were used to estimate adjusted relative risks and 95% confidence intervals for the associations between the pattern of obstetrical transfusion and SMM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 8515 women were enrolled during the study period. The ratio of fresh frozen plasma (FFP) to PRBCs increased dramatically from less than 1:1 to 1:1 from 2009 to 2019, followed by a decrease of the incidence of SMM (from 31.3% in 2009 to 20.0% in 2019). After adjusting, the risks of SMM were generally higher in women with an FFP\/PRBCs ratio of &gt;1:2 to &lt;1:1 and &gt;1:1, but there was no significant difference in the risk of SMM in women with an FFP\/PRBCs ratio of 1:1, when compared with women with an FFP\/PRBCs ratio of \u22641:2. However, subgroup analysis showed that a 1:1 ratio of FFP\/PRBCs resulted in the lowest risk of SMM in women with postpartum blood loss of 2500\u2009mL or more, while a \u22641:2 ratio of FFP\/PRBCs resulted in the lowest risk of SMM in women with postpartum blood loss of less than 2500\u2009mL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A 1:1 ratio of FFP\/PRBCs resulted in best maternal outcomes in women with postpartum blood loss of 2500\u2009mL or more.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70436","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T08:30:26Z","timestamp":1754555426000},"page":"928-937","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The pattern of massive obstetrical transfusion and the risk of severe maternal morbidity: A nationwide retrospective cohort study in China"],"prefix":"10.1002","volume":"172","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7511-0042","authenticated-orcid":false,"given":"Meng","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Obstetrics West China Second University Hospital, Sichuan University  Chengdu Sichuan China"},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education Sichuan University  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangyu","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Peking University Third Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoning","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics West China Second University Hospital, Sichuan University  Chengdu Sichuan China"},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education Sichuan University  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiantian","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics West China Second University Hospital, Sichuan University  Chengdu Sichuan China"},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education Sichuan University  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guolin","family":"He","sequence":"additional","affiliation":[{"name":"Department of Obstetrics West China Second University Hospital, Sichuan University  Chengdu Sichuan China"},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education Sichuan University  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huifeng","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Peking University Third Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianmin","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Shenzhen Maternity &amp; Child Healthcare Hospital  Shenzhen Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yajuan","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics The Third Affiliated Hospital of Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Beijing Obstetrics and Gynecology Hospital, Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianlan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics The First Affiliated Hospital of Zhengzhou University  Zhengzhou Henan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology  Wuhan Hubei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Tan","sequence":"additional","affiliation":[{"name":"Chinese Evidence\u2010Based Medicine Center and National Clinical Research Center for Geriatrics West China Hospital, Sichuan University  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7366-0825","authenticated-orcid":false,"given":"Xinghui","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics West China Second University Hospital, Sichuan University  Chengdu Sichuan China"},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education Sichuan University  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.12"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318185a9ad"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002351"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2022.10.002"},{"key":"e_1_2_9_7_1","first-page":"112","article-title":"Patient blood management in obstetrics: prevention and treatment of postpartum haemorrhage. A NATA consensus statement","volume":"17","author":"Mu\u00f1oz M","year":"2019","journal-title":"Blood Transfus"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/OGX.0000000000001061"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2011.04.042"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13864"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.5402\/2012\/854064"},{"key":"e_1_2_9_12_1","first-page":"401","article-title":"Guidelines for prevention and treatment of postpartum hemorrhage (2023)","volume":"58","author":"Obstetrics Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association","year":"2023","journal-title":"Zhonghua Fu Chan Ke Za Zhi"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14116"},{"issue":"3","key":"e_1_2_9_14_1","first-page":"1","article-title":"WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss)","volume":"1","author":"Say L","year":"2004","journal-title":"Reprod Health"},{"key":"e_1_2_9_15_1","unstructured":"Centers for Disease Control and Prevention.Identifying Severe Maternal Morbidity (SMM). Accessed May 15 2024.https:\/\/www.cdc.gov\/maternal\u2010infant\u2010health\/php\/severe\u2010maternal\u2010morbidity\/icd.html."},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.07.050"},{"key":"e_1_2_9_17_1","unstructured":"National Health Commission of the People's Republic of China.[Standard of recommendation for weight gain during pregnancy period]. Accessed July 28 2022.http:\/\/www.nhc.gov.cn\/wjw\/fyjk\/202208\/864ddc16511148819168305d3e576de9\/files\/4c0e42b584dd4c25b1a4004dd260d561.pdf."},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004477"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.12076"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0098"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e31826f084d"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.13856"},{"key":"e_1_2_9_23_1","first-page":"169","article-title":"Transfusion strategy for patients with severe postpartum hemorrhage: a retrospective study of 47 cases","volume":"25","author":"Khouadja H","year":"2016","journal-title":"Pan Afr Med J"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13831"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.16524"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1728833"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.4103\/0974-2700.166597"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.14571"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2007.01404.x"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc12685"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318202e486"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12605"}],"container-title":["International Journal of Gynecology &amp; Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.70436","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ijgo.70436","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.70436","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T05:03:22Z","timestamp":1791176602000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/ijgo.70436"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,7]]},"references-count":31,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/ijgo.70436"],"URL":"https:\/\/doi.org\/10.1002\/ijgo.70436","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,7]]},"assertion":[{"value":"2025-02-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}