Blood Transfusion In Obstetrics Research Articles

Obstetric blood transfusion in placenta previa patients with prenatal anemia: a retrospective study

BackgroundThe appropriate use of obstetric blood transfusion is crucial for patients with placenta previa and prenatal anemia. This retrospective study aims to explore the correlation between prenatal anemia and blood transfusion-related parameters in this population.MethodsWe retrieved the medical records of consecutive participants who were diagnosed with placenta previa and underwent cesarean section in our hospital. We compared the baseline demographics and clinical characteristics of patients with and without anemia. The correlation between prenatal anemia and obstetric blood transfusion-related parameters was evaluated using multivariate regression analysis.ResultsA total of 749 patients were enrolled, with a mean prenatal hemoglobin level of 10.87 ± 1.37 g/dL. Among them, 54.87% (391/749) were diagnosed with anemia. The rate of obstetric blood transfusion was significantly higher in the anemia group (79.54%) compared to the normal group (44.41%). The median allogeneic red blood cell transfusion volume in the anemia group was 4.00 U (IQR 2.00–6.00), while in the normal group, it was 0.00 U (IQR 0.00–4.00). The prenatal hemoglobin levels had a non-linear relationship with intraoperative allogeneic blood transfusion rate, massive blood transfusion rate, red blood cell transfusion units, and fresh plasma transfusion volume in patients with placenta previa, with a threshold of 12 g/dL.ConclusionsOur findings suggest that prenatal anemia is associated with a higher rate of blood transfusion-related parameters in women with placenta previa when the hemoglobin level is < 12 g/dL. These results highlight the importance of promoting prenatal care in placenta previa patients with a high requirement for blood transfusion.

Blood Transfusion in Obstetrics and Gynecology: A Retrospective Analysis in Government Naseerullah Babar Hospital Peshawar

OBJECTIVES: To evaluate the indications of blood transfusion in the Obstetrics and Gynecology Department of Government NaseerUllah Khan Babar Memorial Hospital. METHODOLOGY: This retrospective observational study was performed on indoor gynecology and obstetrics patients for the period of one year, a total of 100 patients were included in this study that received blood transfusion. Samples were collected by non-random convenience sampling after getting approval from the hospital ethical committee. Data was analyzed by using SPSS version 20. RESULTS: In this study a total of 100 patients who received blood transfusion were analyzed, out of 100 patients 78% of patients received transfusion due to obstetrical causes and 22% patients got transfused for gynecological causes. Most common blood group transfused was B+ and O+ and mean hemoglobin level at which patients received blood transfusion was 9.7g/dl. Blood components preparation can provide components to treat two to three patients from a single donor. The use of packed cell transfusion should be promoted instead of whole blood transfusion that is not even needed in most of the cases. CONCLUSION: Blood transfusion practice has been used aggressively in gynecology and obstetrics in some cases even without proper indications. There is a need to modify this practice by correcting anemia through drugs to avoid the inappropriate use of blood. Use of blood components should be encouraged.

Blood transfusion practices in obstetric patients at a tertiary care institute during COVID-19 first wave: The need to re-strategize

The COVID-19 pandemic has had an enormous impact on all aspects of life, including the blood transfusion practice. We tried to explore the reasons for blood transfusion in detail for each obstetric case that required it. Our aims were to- 1. Study the incidence of blood transfusion in obstetrics 2. Determine the reason behind the need for blood transfusion3. Follow-up to obtain history about prophylactic iron supplementation Out of 6049 admissions in 2020, 211 (3.4%) patients required blood product transfusion (which included two maternal mortalities). Commonest indication for blood transfusion was anemia(63.5%) followed by obstetrical hemorrhage (34.12%). Patients(60.6%) contacted telephonically indicated poor compliance to oral iron. The analysis of blood transfusions during a COVID-19 wave shows unpreparedness to cope with an enormous shortage of blood products, exposing a loophole. Hence innovative ideas and an investigation into non-compliance toward iron tablets is the need of the moment.

Review on blood transfusion during pregnancy and postnatal period

ABSTRACT Patient blood management is a crucial area introduced in almost all medical specialities, such as cardiac surgery, anaesthesiology, and orthopaedic surgery, but the PBM is even more critical in emergency obstetric care. Obstetric haemorrhage is one of the most frequent causes of maternal demise. Due to many factors such as comorbidities and physiological changes, estimating blood loss and the precise demand for blood transfusion during pregnancy is difficult. Numerous guidelines are available to assess the need for blood transfusion; however, the developed countries form all those guidelines used in developing countries. As a result, we investigated the various forms of blood transfusion reactions during pregnancy. We also looked at the frequency and risk variables for postpartum blood transfusion responses. Since patient blood management plays a vital role in minimizing Obstetric haemorrhage, we have also reviewed the guidelines for blood transfusion in obstetrics. Keywords: Blood transfusion, Patient blood management, Obstetric haemorrhage, Blood transfusion reactions, morbidity.

Study of blood component therapy in a tertiary level care hospital in Ghaziabad

Introduction: Pregnancy and labour present with many complications, which result in extra blood loss causing hemodynamic instability. This leads to a need of blood transfusion in the day-to-day practice of obstetrics. In a low resource country like India it becomes necessary to titrate the use of Blood components. With this in background we aim to study the usage of blood components in obstetrics in our hospital. Methodology: It was an Observational cross sectional study. All obstetric patients who were transfused with blood components in the Department Of Obstetrics and Gynaecology in the hospital from January 2018 - September 2019 were recruited in the study. The indications, components transfused and indications of single unit transfusion were noted. Results: Transfusion rate was found to be 3.1%. Anaemia and postpartum haemorrhage were the major causes for blood and blood product transfusion. Single unit transfusion was 55.1%. Anaemia in pregnancy was the major indication of single unit PRBC transfusion. Conclusion: There must be a focus on reduction of unnecessary transfusions especially in conditions, which can be managed effectively by other means. Keywords: Blood Transfusion in obstetrics, Single unit transfusion, Blood components, Active management of third stage of labour

Role of blood transfusion in obstetrics

Blood transfusion in obstetrics should be administered to save the patient's life. Severe blood loss could lead to hypovolemic shock which requires an immediate blood transfusion to prevent organ failure and death. Transfusion of blood and blood components must be approached like the use of medicines. They must be used only after weighing the benefits against the risks as well as in the right dose, right indication, and schedule. This review article deals with preparation, indications, administration of blood components, and its complications in obstetrics.

Outcomes of subsequent pregnancy following obstetric transfusion in a first birth.

BackgroundIncreasing rates of postpartum haemorrhage and obstetric transfusion mean that more women are entering subsequent pregnancies with a history of blood transfusion. This study investigates subsequent pregnancy outcomes of women with a prior obstetric red cell transfusion, compared to women without a transfusion.MethodsAll women with a first pregnancy resulting in a liveborn singleton infant of at least 20 weeks gestation delivering in hospitals in New South Wales, Australia, between 2003 and 2012 were included in the study, with followup for second births until June 2015. Linked hospital and births data were used to identify women with a transfusion and/or postpartum haemorrhage in their first birth, time to second pregnancy and adverse birth outcomes (including transfusion, postpartum haemorrhage and severe morbidity) in their subsequent birth.ResultsThere were 358,384 singleton births to primiparous women, with 1.4% receiving an obstetric blood transfusion. Sixty-three percent of women had at least one subsequent birth. The relative risk (RR) of requiring a transfusion in a second birth was 4.9 (95% CI 4.1,6.1) for women with a previous transfusion compared with women without. The risk (RR) of severe morbidity in a second birth was 4.1 times higher (95% CI 2.2,7.4) for those receiving a transfusion without haemorrhage in their first birth compared with women with neither haemorrhage nor transfusion.ConclusionIt is important to consider a woman’s history of transfusion and/or haemorrhage as part of her obstetric history to ensure management in a manner that minimises risk in subsequent pregnancies.

Retrospective analysis of all patients undergoing blood transfusion in obstetrics at a Tertiary Care Hospital, Belgaum: A cross-sectional study

OBJECTIVES: This study was conducted to know the various indications of blood transfusion (blood and blood products) in obstetrics and to know transfusion reactions if any. METHODOLOGY: This study was done from September 2014 to September 2015 in the Department of Obstetrics and Gynaecology, KLE Dr. Prabhakar Kore Charitable Hospital and Medical Research Centre, Belagavi. All women who received blood and blood product transfusion for any obstetric cause during this period were analyzed to know the indications for transfusion and to know transfusion reactions. RESULTS: A total of 204 women received blood and blood products transfusion in this study. The indications for blood and blood product transfusion observed in our study were anemia, obstetric hemorrhage, hemolysis, elevation of liver enzymes and low platelets, thrombocytopenia, disseminated intravascular coagulopathy, ruptured ectopic, ruptured uterus, and others (incomplete abortion, complete abortion, hydatidiform mole, and persistent trophoblastic disease). Anemia in pregnancy was the most common indication and was observed in 121 cases (58.45%) followed by Obstetric hemorrhage, which was seen in 40 cases (19.32%). The incidence of transfusion reactions was 4.41% in our study. CONCLUSION: A proper knowledge for blood and blood product transfusion is needed to make it available for people who are actually in need and also to decrease the economic burden. The appropriateness of utilization of blood and blood products lies with the physicians' compliance with blood transfusion guidelines. Anemia followed by obstetric hemorrhage still persists to be a major cause for blood and blood product transfusion. Measures to prevent anemia should be implemented. Obstetric hemorrhage is an emergency situation and cannot always be avoided or prevented. The development of various strategies to avoid transfusion reactions is needed.

Increasing incidence of postpartum hemorrhage: the Dutch piece of the puzzle.

An increase of postpartum hemorrhage (PPH) has been reported in many high-income countries. In addition to this data, this study reports on trends in the incidence of PPH in the Netherlands in 2000-2013, and examines the extent to which temporal changes in risk indicators could explain a possible change in incidence of PPH. We used data from the Dutch Perinatal Registry, which contains prospectively collected antenatal, peripartum and neonatal data of 95-99% of all women and neonates in the Netherlands. We selected births ≥22 weeks of gestation from January 2000 until December 2013. Changes in the incidence of PPH and its risk indicators were studied over time. Main outcome measure was PPH, defined as blood loss >1000 mL within 24 h following delivery. The data comprised 2 406 784 women. The incidence of PPH rose significantly from 4.1% in 2000 to 6.4% in 2013 (p < 0.0001). The incidence of previously identified risk indicators for PPH increased over time. Manual removal of placenta was strongly associated with PPH (OR 29.3, CI 28.8-29.8). The incidence of PPH-related blood transfusion decreased remarkably. In line with international observations, Dutch data suggest a considerable increase in the incidence of PPH which can only partly be explained by the studied risk indicators. The decreasing incidence of obstetric blood transfusion suggests an increased incidence of blood loss of 1000-1500 mL.

Single-unit transfusions in the obstetric setting: a qualitative study.

The rate of obstetric blood transfusion is increasing, and there is hospital variation in its use. Recent Australian guidelines recommend a restrictive transfusion strategy in maternity patients who are not actively bleeding and advocate single-unit red blood cell (RBC) transfusions followed by clinical reassessment to determine the need for further transfusion. The aim of this study was to identify factors influencing single RBC unit use when initiating transfusion in a postpartum woman with noncritical bleeding. A qualitative research study using semistructured interviews was conducted. Nine maternity hospitals were chosen to cover a range of clinical settings and obstetric transfusion rates in Australia. Interviews were conducted with the key decision makers in obstetric blood transfusion. Interviews were transcribed and coded, and themes were developed. One hundred twenty-five interviews were conducted, including 61 doctors' interviews among obstetric (n = 42) and hematology (n = 19) staff. Most doctors (54%) interviewed would initiate transfusion with 2 RBC units; and, of those who started with single-unit transfusions, most (63%) had practiced obstetrics for less than 5 years. Clinician and external factors influenced decision making. Important clinician factors included perceived utility or clinical need and education/experience. External factors included influence of colleagues, clinical context, availability of RBC units, and regulation mechanisms. The decision to use single-unit RBC transfusion varied between and within hospitals. Efforts to reduce exposure to blood in the obstetric setting via the number of units transfused may need to target perceptions regarding the utility of single units and lack of experience with this approach.

Intravenous iron: barriers and facilitators to its use at nine maternity hospitals in New South Wales, Australia.

Anaemia in pregnancy is mostly due to iron deficiency, and the use of intravenous (IV) iron is gaining acceptance as a treatment option. Recently released obstetric transfusion guidelines recommend IV iron for obstetric patients in certain situations, including when oral formulations are poorly tolerated, unlikely to be well absorbed, or when rapid restoration of iron stores is required. To identify barriers and facilitators to the use of IV iron in pregnancy among nine maternity hospitals in New South Wales, Australia. A qualitative research study was undertaken using semi-structured interviews. Nine maternity units were chosen to cover a range of clinical settings and obstetric blood transfusion rates. Interviews were conducted with haematologists, obstetricians and midwives, and included questions about the use of IV iron in each institution. Interviews were transcribed and coded, and NVivo software was used to develop themes. A total of 125 interviews were conducted: 61 with doctors. The use of IV iron differed between hospitals and individual doctors. There were hospital/pharmaceutical, clinician and patient factors which acted as either barriers or facilitators to the use of IV iron. Where perceived barriers outweighed facilitators in a particular hospital, doctors were less likely to use IV iron. The use of IV iron, as perceived by doctors, differed across hospitals. There are some potentially modifiable barriers to the use of IV iron that may need to be addressed for IV iron to be available to obstetric patients not tolerating oral formulations or requiring rapid restoration of iron stores.

Blood transfusion in obstetrics.

Transfusion of blood and blood components is a common practice in obstetric wards but it is not without risk. The incidence of transfusion reactions varies from 4 in every hundred transfusions for non-haemolytic reactions to one in every 40,000 for haemolytic transfusion reactions. The physiological basis of blood transfusion is outlined in this article. Most of the donated blood is processed into components: packed red cells (PRBCs), platelets, and fresh frozen plasma (FFP) or cryoprecipitate. Various alternatives to blood transfusion exist and include autotransfusion, pre-autologous blood storage, use of oxygen carrying blood substitutes and intraoperative cell salvage. Despite the risks associated with transfusions, obstetricians are frequently too aggressive in transfusing blood and blood products to their patients. Acute blood loss in obstetrics is usually due to placenta praevia, postpartum blood loss and surgery related. An early involvement of a consultant obstetrician, anaesthetist, haematologist and the blood bank is essential. There are no established criteria for initiating red cell transfusions and the decision is purely based on clinical and haematological parameters, which have been discussed along with the general principles of blood transfusion in obstetrics and some practical guidelines.

Blood or not in the obstetric setting? When should you transfuse?

Introduction: Blood transfusion in obstetrics and gynaecology accounts for 3.8% of red cells transfused in Victoria and 5% in SA according to the Bloodhound project undertaken by the Blood Service. Wrong blood in tube errors occur regularly, 11% of transfusion errors in one study, and can result in an incorrect blood group being recorded. In obstetrics this can lead to inappropriate or missed Anti-D administration for pregnant women, as well as the potential for an ABO incompatible transfusion. The Blood Matters program in Victoria collects transfusion related adverse events, including wrong blood in tube errors (WBIT), via the Serious Transfusion Incident Reporting program (STIR). These data have been collected since 2006. During this time 1473 reports received (to 31/12/14), of which 28% (419/1473) are WBIT reports. Of these 419 reports 30% occur in the maternity or delivery suite, and often involve cord blood specimens. There are specific issues in relation to collection of these specimens that increase the chance of errors occurring. Aim: To make clear the risks of wrong blood in tube errors (WBIT), where the specimen and request are labelled for one patient, but the blood in the tube actually belongs to a different patient and how these errors can be avoided to increase patient safety. This poster will report on several cases studies from STIR that highlight where problems occur, and methods health services are employing to address these problems. Implications: The transfusion chain involves many steps. One of the earliest steps is specimen collection for blood grouping and/or cross-matching. Errors at this point in the chain can have catastrophic results if they lead to incorrect or incompatible transfusion. Knowledge of how WBITs occur will assist staff in avoiding these errors and improve patient safety.

What informs choice in obstetric transfusion decision-making?

Background Most obstetric blood transfusions occur in the setting of postpartum haemorrhage (PPH). Blood is precious, not risk-free and some women can be safely managed without a blood transfusion. Aim To identify factors associated with variation in obstetric transfusion rates, and to explore postpartum transfusion triggers across institutions with a range of transfusion rates. 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 in person with the key decision-makers in the maternity blood transfusion process: haematologists, obstetricians, midwives, midwifery unit managers and clinical midwifery educators. Interviews were transcribed, coded, and NVivo qualitative software was used to develop themes. Results 126 interviews were conducted: 61 clinician interviews were coded in detail and the rest provided contextual data. High transfusing hospitals were more likely to be rural, treat lower risk women, have lower staff numbers and skill-mix, have smaller blood inventories with less blood product regulation, and have lower tolerance for maternal anaemia. Discussion This study identifies hospital-based, clinician-based and patient-based factors influencing obstetric blood transfusion practice. Different factors predominate in each institution, and identifying potentially modifiable factors may provide a focus for practice improvement.

Blood transfusion trends in obstetrics at the Federal Teaching Hospital in Abakaliki, South-East Nigeria

BackgroundObstetric hemorrhage has been repeatedly implicated as a leading cause of maternal mortality in Nigeria, yet there are very few studies that evaluate the practice of blood transfusion in obstetrics as a life saving measure.ObjectivesThe aim of this study was to evaluate the practice of obstetric blood transfusion, the mean decision-transfusion interval, and the outcome in parturients who had blood transfusions.MethodsThis was a prospective descriptive study conducted at the Federal Teaching Hospital, Abakaliki, South-East Nigeria, between 1st January, 2012 and 31st December, 2012. Statistical analysis was done using SPSS version 15.0 for Windows.ResultsOut of 151 parturients who received blood transfusion, 141/151 (97.4%) were knowledgeable about blood transfusion, while only 10/151 (2.6%) had no knowledge of it. The hospital was the source of information for 120/151 (80.8%) of the participants. Blood transfusion rate was 7.04% of all parturients. The mean decision-transfusion interval was 12.0 ± 4.3 hours. All participants were transfused with either whole blood or sedimented cells. The mean number of blood units transfused was 1.77 ± 0.93 units. The indications for transfusion were: anemia, 109/151 (72.2%); shock, 13/151 (8.6%); postpartum hemorrhage, 23/151 (15.2%); antepartum hemorrhage, 6 (4%). Six (4%) women died; mortality was due to renal failure in 3/6 (50%) and disseminated intravascular coagulopathy in 3/6 (50%). These deaths were due to delays and difficulty in securing blood for transfusion, while those who got transfused on time were salvaged with minimal morbidity, 21/151 (14%), or with no morbidity, 130/151 (86%).ConclusionExcessive blood loss and anemia still complicate most pregnancies in our practice and the mean decision-transfusion interval is unacceptably long with debilitating maternal morbidity and mortality that can be improved with safe and effective blood transfusion with minimal or no risk.

P-072 Recurrent spontaneous abortion in women with bleeding disorders

P-072 Recurrent spontaneous abortion in women with bleeding disorders

Severe hypotension related to cell salvaged blood transfusion in obstetrics

Intra-operative blood cell salvage has recently been adopted for use in women at risk of significant haemorrhage during caesarean section. It has also been advocated for use in those patients who refuse allogenic blood transfusion. A 37-year-old pregnant woman (gravida 3, para 2) underwent an elective lower segment caesarean section at 36 weeks for an anterior, major placenta accreta (grade 4). The volume of cell salvaged blood collected during the procedure was 1870 ml. On starting the cell-salvaged blood transfusion, the blood pressure was noted to fall and this was temporally related to the transfusion of the cell-salvaged blood. We review the recent literature and case reports on hypotension related to cell-salvaged blood transfusion.

Blood transfusion in obstetrics: The pregnant women's point of view

SummaryThe objective of this study was to determine the views and compliance of a group of pregnant women regarding obstetric-related blood transfusion. In this prospective questionnaire-based analysis, a total of 300 pregnant women who attended the antenatal care clinic were included. The mean age and gestational age of patients were 31.6 years and 27.4 weeks, respectively. All demographic and questionnaire data were recorded and analysed. A total of 41% of participants were aware of the possible need for blood transfusion in pregnancy and 88% of all women would accept blood transfusion when necessary. The remaining 12% would refuse blood transfusion, even if it was life-saving, because of the fear of blood transfusion complications. It is concluded that counselling and a management plan should be scheduled for pregnancy, and management protocols should be developed for women who refuse blood transfusion. Transfusion alternatives should be discussed with women who will not accept the allogenic blood transfusion.

Trends in Blood Transfusion in Obstetrics

Trends in Blood Transfusion in Obstetrics

Uses and misuse of blood transfusion in obstetrics in Lagos, Nigeria.

The objectives of this study were to identify obstetric and medical conditions in transfused patients, appraise the justification for the transfusion and recommend measures for reducing transfusion in obstetrics in Nigeria. Available case records of obstetric patients transfused at the Lagos University Teaching Hospital between the period 1st November 1995 and 31 October 1998 were reviewed retrospectively. Data collected included booking status, mode of delivery, amount of blood-transfused, post transfusion packed cell volume (PCV), and obstetric and medical conditions found in the patients. There were 4,159 cases out of which 503 were transfused. The overall transfusion rate was 12.1%, in booked and unbooked patients, it was 6.6% and 45.8% respectively. Only 231 cases were available for full analysis, mean age was 28.9 +/- 5.2 years (range 16-43 years). Sixty-three (27.3%) had unit-transfusions. Mean post transfusion PCV was 28.4% +/- 4.3% (range 17%-43%). In 63 (27.3%), the post transfusion PCV was above 30%. Some of the obstetric and medical conditions in the transfused patients were caesarean section (68.8%), previous caesarean section (20.4%), antepartum haemorrhage (16.9%), pregnancy induced hypertension (15.6%), anaemia and malaria (14.0%), induction of labour (13.0%), ruptured uterus (8.8%), and sickle cell anaemia (5.2%). Multi-unit transfusions were found in ruptured uterus (5.8 units), sickle cell anaemia (4.9 units), vaginal and cervical lacerations (4.0 units), forceps delivery (3.9 units) and malaria and anaemia (2.9 units). The study shows a high transfusion rate; an appreciable number were unnecessary transfusions. A number of the obstetric and medical factors for blood transfusion were avoidable. A reduction in blood transfusion rate can be achieved by the provision of adequate, available and affordable maternal health services in Nigeria.