How does the use of intravenous iron differ in hospitals with above and below average obstetric transfusion rates?

Abstract

Background Obstetric transfusion rates vary across hospitals in NSW. Anaemia in pregnancy is commonly due to iron deficiency. Some obstetricians use intravenous (IV) iron to replenish iron stores prior to delivery, in an effort to reduce the need for maternal blood transfusion. Aim To examine whether the use of IV iron differs in hospitals with above and below average obstetric transfusion rates, and to identify the factors influencing this. Methods A qualitative research study using semi-structured interview was conducted. Nine maternity units were chosen to cover a range of clinical settings and obstetric transfusion rates. Interviews were conducted with the key decision-makers in the maternity blood transfusion process, and included questions about the use of IV iron in each institution. Interviews were transcribed, coded, and NVivo qualitative software used to develop themes. Results 126 interviews were conducted: 61 clinician interviews were coded in detail and the rest provided contextual data. The use of IV iron differed across hospitals and between individual clinicians. There were clinician, patient and hospital-based factors contributing to this difference. Discussion The uptake of IV iron does not correlate with a particular obstetric transfusion rate, suggesting that the transfusion rate is determined by multiple factors rather than IV iron alone.