Red blood cell transfusion in obstetrics and its implication for patient blood management: a retrospective analysis in Switzerland from 1998 to 2016

Jarmila A Zdanowicz,Sophie Schneider,Martin Mueller,Ruedi Tschudi,Daniel Surbek

doi:10.1007/s00404-020-05744-7

Jarmila A Zdanowicz, Sophie Schneider + Show 3 more

Open Access

https://doi.org/10.1007/s00404-020-05744-7

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Abstract

PurposePeripartum hemorrhage (PPH) remains one of the main causes of maternal mortality worldwide. Treatment includes administration of packed red blood cells (RBC) in severe cases and patient blood management (PBM) may reduce it significantly. In our study, we wanted to retrospectively assess red blood cell administration in PPH to evaluate the impact of PBM in Switzerland.MethodsUsing data from the Swiss obstetric hospital registry (Arbeitsgemeinschaft Schweizer Frauenkliniken, ASF), we included patients with deliveries from 1998 to 2016. We examined available obstetric data as well as blood loss and RBC administration in the acute and subacute peripartal phase. We categorized data into two time intervals: 1998–2011 and 2012–2016, as new PPH guidelines in Switzerland were established in 2012.ResultsPPH incidence increased between 1998 and 2016 significantly. The number of vaginal instrumental deliveries and cesarean sections increased as well. Administration of three or more RBC units, as defined in the ASF registry, in the acute and subacute phase in Switzerland has decreased after 2012. Conversely, we saw an increase in the administration of one to two RBC units in the acute and subacute phase. Nevertheless, overall RBC administration has been decreasing from 1998 to 2016.ConclusionThe increase of patients obtaining one or two units of RBC for PPH suggests that there may be a potential for effective implication of PBM in obstetrics. Reduction of RBC transfusion in the context of PPH may not only decrease maternal morbidity, but decrease economic costs as well.

Highlights

Peripartum hemorrhage (PPH) remains one of the leading causes of maternal mortality worldwide, with an incidence of more than 15% [1, 2]
According to the World Health Organization (WHO), PPH is defined as a blood loss of more than 500 ml within 24 h after delivery [3]
Severe PPH usually requires the administration of red blood cell (RBC) transfusions

Summary

Introduction

Peripartum hemorrhage (PPH) remains one of the leading causes of maternal mortality worldwide, with an incidence of more than 15% [1, 2]. We looked at RBC administration in the acute and subacute phase, blood loss, hemoglobin levels, potential PPH risk factors, need for postpartum intensive care unit (ICU) hospitalization, delivery mode and overall obstetric data. A p value < 0.05 was considered significant This was a retrospective database study using data from the Swiss obstetric hospital registry (Arbeitsgemeinschaft Schweizer Frauenkliniken, ASF) which is managed by Sevisa AG. There was an increase in potential risk factors for PPH, including retained placental products, placenta previa, uterine rupture, previous cesarean sections, multiple gestation delivery, induction of labor, prolonged labor, polyhydramnios and amniotic infection syndrome. Instrumental vaginal delivery seems to be associated with an increased need for RBC administration as in the acute phase (Fig. 3b).

Discussion

Findings

Compliance with ethical standards