Figure Legends
Figure 1. Surgical procedures and Experimental protocol.
(A) Rabbits underwent caesarean section to deliver foetuses in the right side of the bicornate uterus. (B) After closing the incision in the uterus, uncontrolled haemorrhage was induced by transecting the right uterine artery and concomitant vein. (C) Pregnant rabbits underwent caesarean section, and uncontrolled haemorrhage was induced to develop severe postpartum haemorrhage (PPH). First, all rabbits were administered 6% HES for initial treatment. After developing severe PPH, rabbits received isovolumic fluid resuscitation with an equivalent volume of haemorrhage every 5 min. Resuscitative administration regimens included the following: RBCs with PPP (vol/vol=1:1, n =8), 6% HES (n =7), or HbVs with 25% human serum albumin (vol/vol=4:1,n =10). After 60 min from the start of bleeding or when the haemorrhage volume reached 200 mL, we performed surgical hemostasis.
CS, caesarean section.
Figure 2. Haemodynamic changes and Suvival curves of all three groups.
(A) Unlike HbV and RBC/PPP group, the mean arterial pressures (MAP) were gradually decreased in HES group, whereas MAP in HbV and RBC/PPP group was maintained over 40 mmHg. (B) Shock index was gradually increased in all groups, but there were no significant differences throughout the experiment. (C) Survival of HbV group was significantly better than that of HES group (p <0.01), whereas it was significantly worse than that of RBC/PPP group (p =0.01).
Values represent the mean ± SD. Statistical comparisons between two groups were performed using Student’s t test. One-way ANOVA and post hoc tests where appropriate were used to identify significant mean differences between three groups. *p <0.05 indicate significant difference. Survival curves were generated using the Kaplan–Meier method and compared using the log-rank test.
p <0.05, the prognosis of RBC/PPP group was significantly different from that of the other groups.
††p <0.05, the prognosis of HbV group was significantly different from that of the HES group.
Figure 3. Changes in haematologic variables and blood gas levels.
(A) At the end of the experiment, the Hb concentration was maintained over 6.0 g/dL in RBC/PPP and HbV groups, whereas it decreased under 2.0 g/dL in HES group. (B) The haematocrit was similarly decreased in both HbV and HES groups, but not in RBC/PPP group. (C) The pH levels in HES group were significantly lower than those in the other groups after 30 min. (D) There were no significant differences in the base excess levels among all groups throughout the experiment. (E) At the end of the experiment, the lactate acid levels were significantly higher in HES group than in the other groups. (F) The CtO2 level was decreased in all groups until 30 min, but it was maintained above approximately 7.0 vol% beyond 30 min in RBC/PPP and HbV groups.
CtO2, arterial oxygen content.
Values represent the mean ± SD. Between-group comparisons were performed using Student’s t test. One-way ANOVA and post hoc testing where appropriate were used to identify significant mean differences between the three groups.
*p <0.05, value significantly different from other groups.
Figure 4. Changes in coagulation variables.
(A) The values of plasma fibrinogen in RBC/PPP group was maintained over 110 mg/dL even at the end of the experiment. (B) The values of AT III in HbV and HES groups were significantly decreased than those in RBC/PPP group at 45 min and at the end of the experiment. (C) The values of PT in HbV and HES groups were significantly longer than that in RBC/PPP group at the end of the experiment. (D) The values of APTT after 30 min was set as the reference value because the value over 75 sec could not be measured in the current analysis.
PT, prothrombin time; APTT, activated partial thromboplastin time.
Values represent the mean ± SD. Statistical comparisons between two groups were performed using Student’s t test. One-way ANOVA and post hoc testing where appropriate were used to identify significant mean differences between the three groups.
*p <0.05 indicates significant difference.
** At the end of the experiments, the APTT levels were unmeasurable in the HbV and HES groups.