Obstetric Transfusion Research Articles

Construction and effect evaluation of prediction model for red blood cell transfusion requirement in cesarean section based on artificial intelligence

ObjectivesThis study intends to build an artificial intelligence model for obstetric cesarean section surgery to evaluate the intraoperative blood transfusion volume before operation, and compare the model prediction results with the actual results to evaluate the accuracy of the artificial intelligence prediction model for intraoperative red blood cell transfusion in obstetrics. The advantages and disadvantages of intraoperative blood demand and identification of high-risk groups for blood transfusion provide data support and improvement suggestions for the realization of accurate blood management of obstetric cesarean section patients during the perioperative period.MethodsUsing a machine learning algorithm, an intraoperative blood transfusion prediction model was trained. The differences between the predicted results and the actual results were compared by means of blood transfusion or not, blood transfusion volume, and blood transfusion volume targeting postoperative hemoglobin (Hb).ResultsArea under curve of the model is 0.89. The accuracy of the model for blood transfusion was 96.85%. The statistical standard for the accuracy of the model blood transfusion volume is the calculation of 1U absolute error, the accuracy rate is 86.56%, and the accuracy rate of the blood transfusion population is 45.00%. In the simulation prediction results, 93.67% of the predicted and actual cases in no blood transfusion surgery; 63.45% of the same predicted blood transfusion in blood transfusion surgery, and only 20.00% of the blood transfusion volume is the same.ConclusionsIn conclusion, this study used machine learning algorithm to process, analyze and predict the results of a large sample of cesarean section clinical data, and found that the important predictors of blood transfusion during cesarean section included preoperative RBC, surgical method, the site of surgery, coagulation-related indicators, and other factors. At the same time, it was found that the overall accuracy of the AI model was higher than actual blood using. Although the prediction of blood transfusion volume was not well matched with the actual blood using, the model provided a perspective of preoperative identification of high blood transfusion risks. The results can provide good auxiliary decision support for preoperative evaluation of obstetric cesarean section, and then promote the realization of accurate perioperative blood management for obstetric cesarean section patients.

Study of Utilization Pattern of Blood And Blood Components in Obstetrics at A Tertiary Care Hospital

Background: Blood transfusion is a life-saving procedure, but inappropriate use of blood and its components in obstetric emergencies, especially in cases of massive bleeding, increases the risk of morbidity and mortality. The aim of this study was to describe the determinants of blood and blood components in obstetrics in a tertiary care hospital with indications for transfusion for different components during the study. Subjects and Method: A Prospective Observational study was carried from May 2018 to December 2019 at Department of Obstetrics and Gynaecolog,T.N.M.C & B.Y.L.Nair Hospital Mumbai. The independent variables are sociodemographic characteristics, parity, mode of delivery, education, hospital level, while dependent variables are frequency of obstetric transfusion. Frequency of transfusion of blood and its components obtained from case file of patient. The other data were collected by questionnaire. Analysis of 366 Obstetric patients requiring blood transfusion in eighteen months period was done. Qualitative data were presented as frequency and percentages and analysed using the chi-square test. Results: During the whole study 366 of obstetric admission required transfusion of blood and its components. Severe anaemia during pregnancy/postpartum anaemia (51%) were the most common indications for blood product transfusions followed by Accidental Haemorrhage (30%), Caesarean section (10.38%) Genital tract trauma including uterine rupture (11%), Postpartum Haemorrhage’s (13%), Placenta previa (6.5%), Ectopic pregnancies (3.5%), Vesicular mole (3.27%), Retained placenta (3.27%) Ruptured uterus (1%), and Abortion (2.7%). Packed cells (47%) were the most common type of blood and blood products transfused followed by Fresh Frozen Plasma (41.86%). Conclusion: : In obstetric emergencies, correct diagnosis and management of emergencies, A pre- planned, multidisciplinary protocol yields excellent effects in the management. Keywords: blood transfusion, pregnancy, anaemia, obstetric emergencies Correspondence: Avinash N. Jadhao. Associate Professor, Department of Biochemistry Seth GSMC & KEMH Parel Mumbai 400012, India. Email: avinashjadhao@kem.edu. Phone no.91 7718971066.

Viscoelastic Testing in an Obstetric Population at High Risk of Hemorrhage.

Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic test used in trauma for goal-directed transfusion. However, there are limited data on baseline ROTEM parameters in the U.S. obstetric population. Obtaining baseline parameters is a first step in implementing a goal-directed massive transfusion protocol in obstetric hemorrhage. Our study aimed to establish pre- and postdelivery baseline parameters in a high-risk obstetric population and determine their association with postpartum hemorrhage (PPH). Prospective observational study of patients ≥34 weeks' gestation, at high risk of PPH, admitted for delivery. INTEM, EXTEM, FIBTEM, and APTEM assays were performed at the time of admission to labor and delivery and then 2 hours after delivery. Primary outcome was pre- and postdelivery ROTEM parameters among women without PPH. A sample size of 60 women was needed for >90% power to detect at least 50% correlation between pre- and postdelivery assuming a loss of 10% of participants to follow-up. Of 60 women in the study, 10 (17%) had PPH. Baseline characteristics were not different between those with or without PPH. Pre- and postdelivery ROTEM parameters were not significantly different except for APTEM. None of the patients who had PPH, compared with 4 (10%) of those who did not, had shortened clotting time and higher maximum clot firmness in postdelivery APTEM compared with EXTEM, a pattern suggestive of hyperfibrinolysis (p = 0.4). In this study, we describe baseline ROTEM parameters in women at high risk of PPH. The majority of patients did not have a ROTEM pattern that is suggestive of hyperfibrinolysis, for which tranexamic acid is thought to be beneficial. Based on our findings, previously established obstetric transfusion thresholds for goal-directed massive transfusion protocols are likely valid for the majority of the obstetric population regardless of the presence of comorbidities or pregnancy complications. · ROTEM parameters do not vary significantly before and after delivery.. · Most patients did not have a hyperfibrinolysis pattern, for which tranexamic acid is thought to be beneficial.. · Previous goal-directed obstetric transfusion thresholds are likely valid in most populations..

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.

Outcomes of audit on blood requisition and utilization in obstetrics and gynaecology setting: Aminu Kano Teaching Hospital, Kano, Nigeria

Background: Indications for transfusion in obstetrics may be emergent as well as non-emergent: the keystone of transfusion practice is that it should be appropriate, that is, not given when not required and not missed when requiredObjectives: To identify key areas where there is a need to change policy so as to prevent unnecessary blood transfusion, to formulate strategies for appropriate preoperative blood requisition and to change clinicians’ approach regarding blood component utilization.Results: The mean age was 30.04 years (SD ± 8.08) and ranged from 16 to 70 years. The incidence of blood transfusion among all admissions was 418 out of 3078 (13.6%). The mean pre-transfusion PCV for patients who received blood transfusion was 23.06 ± 6.1% compared to 34.2 ± 4.54% obtained in the non-transfused patients. Only 59.8% of blood was utilized while 40.2% of blood was not needed.Conclusion: Current practice at O&G department, AKTH appears to be generally inconsistent with the guidelines. This indicates inefficient transfusion practice when comparing with the standard.

1377Did patient blood management guidelines reduce the rate of blood transfusion in pregnancy?

Abstract Background Concern about increasing transfusion rates, adverse effects and increased costs have led to international efforts to reduce transfusion rates. Australian patient blood management guidelines were first introduced for critical bleeding in 2011, followed by obstetric guidelines in 2015. This study examines obstetric transfusion rates before and after the introduction of the critical bleeding and obstetric guidelines, accounting for pregnancy characteristics and prior trajectories. Methods Data were obtained from linked birth and hospital records from NSW between January 2002 and December 2017. Changes in raw and risk adjusted transfusion rates over time were investigated using interrupted time series analysis to assess changes in the trend in rate of transfusion among pregnant women with the introduction of each set of guidelines. Sensitivity analysis was performed to identify patterns in the data independently from the interventions. Results Data for 1,477,001 births in NSW from 2002 to 2017 were available for analysis. Preliminary analysis suggests the increasing rate of transfusion from 2002 was flattened after the introduction of the 2011 guidelines, with a significantly decreasing trend observed after the 2015 obstetric guidelines were introduced. Conclusions Patient blood management guidelines were associated with a reduction in the rate of obstetric transfusion in NSW. Key messages A focus on patient blood management was associated with an approximately 30% reduction in the transfusion rate, compared to the predicted rate, by the end of the study period. Future work will investigate whether this change in transfusion rates is associated with a change in rates of adverse outcomes.

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.

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

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.

Accuracy of Blood Transfusion Records in a Population-based Perinatal Data Registry.

Blood transfusion is frequently used as an indicator of severe maternal morbidity during pregnancy. However, few studies have examined its validity in population perinatal databases. We linked a perinatal database from British Columbia, Canada, with the province's Central Transfusion Registry for 2004-2015 deliveries. Using the Central Transfusion Registry records for red blood cell transfusion as the gold standard, we calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the perinatal database variable for red blood cell transfusion, overall and by transfusion risk factor status. We used multivariable logistic regression to examine whether outcome misclassification altered the odds ratios for different transfusion risk factors. Among 473,688 deliveries, 4,033 (8.5 per 1,000) had a red blood cell transfusion according to the Central Transfusion Registry. The sensitivity of the perinatal database transfusion variable was 72.3 [95% confidence interval (CI) = 72.2, 72.4]. Sensitivity differed according to the presence of many transfusion risk factors (e.g., 84.9% vs. 72.2% in deliveries with versus without uterine rupture). Odds ratios associated with some transfusion risk factors were exaggerated when the perinatal database transfusion variable was used to define the outcome instead of the Central Transfusion Registry variable, but 95% confidence intervals for these estimates overlapped. Blood transfusion was documented with reasonable sensitivity in this large population perinatal database. However, validity varied according to risk factor status. Our findings enable researchers to better account for outcome misclassification in studies of obstetrical transfusion risk factors.

Intraoperative cell salvage is associated with reduced allogeneic blood requirements and has no significant impairment on coagulation function in patients undergoing cesarean delivery: a retrospective study.

The aim of the study is to examine the association between Intraoperative cell salvage (ICS), allogeneic blood transfusion (ABT) and coagulation function in obstetrics. A total of 486 pregnant women undergoing cesarean delivery, of whom 157 were enrolled in this retrospective study. Patients were divided into ICS group (n = 101, ICS used during operation) and control group (n = 56, ICS not used during operation). Clinical data, including plasma prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib) and thrombin time (TT) levels, were collected from all patients preoperatively (within 12-24h) and postoperatively (within 6-12h) and analyzed by t test, two-way repeated-measures ANOVA and Spearman's correlation. The use of ICS is associated with lower requirement rate for ABT (P < .001), while the blood loss was similar between the two groups (P = .990). Mean volume of ICS transfusion was 432.65mL. Compared to preoperative values, the postoperative PT and APTT levels were significantly increased, while Fib was decreased in the two groups (all P < .01). No significant difference in coagulation function was observed between groups in preoperative and postoperative phase (P > .05). Furthermore, PT, APTT and TT after surgery were not correlated with the transfused volume of salvaged blood (P > .05) while the levels of Fib were negatively correlated with the volume (P < .01). In addition, there were no transfusion reactions in both two groups. Intraoperative cell salvage is correlated with reduced allogeneic blood requirements but did not impair blood coagulation significantly in patients undergoing cesarean delivery.

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

An investigation of emergency obstetric transfusion cases and the manual on how to respond to critical obstetric bleeding in a pediatric hospital

An investigation of emergency obstetric transfusion cases and the manual on how to respond to critical obstetric bleeding in a pediatric hospital

Polymorphism of human platelet antigens in Tunisian population: Clinical and anthropological interests

Human Platelet Antigens (HPA) are of considerable interest in obstetric transfusion medicine and anthropological genetics. This study aims to provide clinicians with a detailed database of HPA antigenic variants, which allows them to estimate the probability of allo-immunisation of each antigen. In addition, it aims to make an interethnic comparison of the Tunisian population with other populations. The target population consists of 324healthy and unrelated Tunisian blood donors recruited from the National Blood Transfusion Center in Tunis. DNA extraction was performed by the Salting Out method and molecular genotyping was performed by the PCR-SSP technique. The statistical analysis was performed using two approaches: manual calculation and computerized calculation. Phylogenetic trees were constructed through the use of Standard Genetic Distances that were calculated from allelic frequencies. With the exception of the HPA-4 system, statistical analysis showed that all HPA systems are polymorphic especially the two systems HPA-3 and HPA-15. The inter-ethnic analysis showed that Tunisians are closer to North Africans and Caucasians than Sub-Saharan and Asian populations, which shows genetic mixing between Tunisians, Arabs, Europeans and Africans. The results of this study could be exploited to prepare a ready-to-use genotyping plate dedicated to HPA antigens, with the aim of ensuring better management, especially for polytransfused patients.

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.

Assessing the effect of risk factors on rates of obstetric transfusion over time using two methodological approaches

BackgroundWhile red blood cell transfusion rates have declined in most Australian medical specialties, obstetric transfusion rates have instead been increasing. Obstetric transfusions are mostly linked to postpartum haemorrhage, the rates of which have also increased over time. This study used two methodological approaches to investigate recent trends in obstetric transfusion in New South Wales (NSW) and the extent to which this was influenced by changing maternal and pregnancy characteristics.MethodsLinked birth and hospital records were used to examine rates of red blood cell transfusion in the postpartum period for mothers giving birth in NSW hospitals from 2005 to 2015. Logistic regression models were run to examine the contribution of maternal and pregnancy risk factors to changing rates of transfusion. Risk factors were divided into “pre-pregnancy” and “pregnancy related”. Crude and adjusted estimates of the effect of year of birth on obstetric transfusion rates were compared to assess the effect of risk factors on rates over time using two approaches. The first compared actual and predicted odds ratios of transfusion for each year. The second compared the observed increase in transfusion rate with that predicted after controlling for the risk factors.ResultsAmong 935,659 births, the rate of obstetric transfusion rose from 13 per 1000 births in 2005 to 17 in 2011, and remained stable until 2015. From 2005 to 2015, postpartum haemorrhage increased from 74 to 114 per 1000 births. Compared with the rate in 2005, the available maternal and pregnancy characteristics only partially explained the change in rate of transfusion by 2015 (Method 1, crude odds ratio 1.39 (95% CI 1.25, 1.56); adjusted odds ratio 1.29 (95% CI 1.15, 1.45)). After adjustment for maternal and pregnancy characteristics, obstetric transfusion incidence was predicted to increase by 10.3%, but a 38.7% increase was observed (Method 2).ConclusionRates of obstetric transfusion have stabilised after a period of increase. The trend could not be fully explained by measured maternal and pregnancy characteristics with either of the two approaches. Further investigation of rates and maternal and clinical risk factors will help to inform and improve obstetric blood product use.

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.

The Epidemiology and Outcomes of Women With Postpartum Hemorrhage Requiring Massive Transfusion With 8 or More Units of Red Cells: A National Cross-sectional Study

(BJOG. 2016;123:2164–2170) The frequency of postpartum hemorrhage (PPH) and the rates of severe adverse outcomes associated with PPH have increased in developed countries over the last 10 to 15 years. PPH also remains a leading cause of maternal morbidity and mortality worldwide. The multifactorial approach to treating PPH consists of early identification and supportive resuscitation, along with pharmacological, mechanical and surgical methods to control bleeding. A population-based cross-sectional study was undertaken using the United Kingdom Obstetric Surveillance System to determine the incidence of massive transfusion (MT) in obstetrics in the UK and to determine the management practices used and the outcomes for parturients receiving MT.

National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review.

In developed countries, rates of postpartum hemorrhage (PPH) requiring transfusion have been increasing. As a result, anesthesiologists are being increasingly called upon to assist with the management of patients with severe PPH. First responders, including anesthesiologists, may adopt Patient Blood Management (PBM) recommendations of national societies or other agencies. However, it is unclear whether national and international obstetric societies' PPH guidelines account for contemporary PBM practices. We performed a qualitative review of PBM recommendations published by the following national obstetric societies and international groups: the American College of Obstetricians and Gynecologists; The Royal College of Obstetricians and Gynecologists, United Kingdom; The Royal Australian and New Zealand College of Obstetricians and Gynecologists; The Society of Obstetricians and Gynecologists of Canada; an interdisciplinary group of experts from Austria, Germany, and Switzerland, an international multidisciplinary consensus group, and the French College of Gynaecologists and Obstetricians. We also reviewed a PPH bundle, published by The National Partnership for Maternal Safety. On the basis of our review, we identified important differences in national and international societies' recommendations for transfusion and PBM. In the light of PBM advances in the nonobstetric setting, obstetric societies should determine the applicability of these recommendations in the obstetric setting. Partnerships among medical, obstetric, and anesthetic societies may also help standardize transfusion and PBM guidelines in obstetrics.