Blood Transfusion during caesarean delivery

Abstract

Introduction: Blood transfusion is considered as a life saving measure in obstetrics. However, at present it is not considered safe all the time due to transfusion reactions and infections. The mother is at risk of increased bleeding, because caesarean section may result in twice the blood loss of vaginal delivery (due to placental attachment and two surgical scars). In Sri Lankan setup, grouping and cross matching are done prior to each and every caesarean section without considering the presence or absence of risk factors even with less facilities available. During caesarean section in Sri Lanka blood transfusion to cross matching ratio is considered to be low. Objectives: To determine the proportion of blood transfusions performed among mothers whose blood was grouped and cross-matched for Lower segment caesarean section (LSCS). To find out the indications/ associated factors for blood transfusion in LSCS Method & Materials: A retrospective cross sectional study carried out in Obstetric Units, General Hospital Matara Sri Lanka. Data collected from all the bed head tickets and other records available at Blood Bank General Hospital Matara belong to mothers who underwent elective and emergency caesarean sections from 30th July 2013 to 1st of June 2014 Results: Our sample size was 3174 mothers majority underwent Elective Lower segment caesarean section (EL/LSCS) (57.5%) & 42.5% were Emergency Lower segment caesarean section (EM/LSCS). Only 1.85% of mothers transfused blood during LSCS, as 3.38% during EL/LSCS & 96.6% during EM/LSCS. Lower segment large fibroid (50%) & placenta accreta + past section (50%) were two indications that need blood transfusion during EL/LSCS in our research. Antepartum haemorrhage (APH) (15.78%), pregnancy induced hypertension (PIH) (8.77%), postpartum haemorrhage (26.31%), Anaemia Hb 7.6-8.2g/dl (36.84%), Twin pregnancy (5.26%) & placenta previa were other indication that need blood transfusion in EM/LSCS. Conclusions: This study shows each & every mother who undergo EL/LSCS do not need blood transfusion & cross matching especially in EL/LSCS. According to our study patients with following risk factors need blood grouping & cross matching. APH, PIH, Placental abnormalities, Anaemia (Hb 7.6-8.2g/dl), Twin pregnancy, and pregnancy complicated with abnormal uterine condition eg: - fibroids, placenta accrete.