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.