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Transfusion practices in postpartum hemorrhage: a population-based study.: Transfusion in Postpartum Haemorrhage

Abstract : OBJECTIVE: To describe transfusion practices and anemia in women with postpartum hemorrhage (PPH), according to the clinical context. DESIGN: Population-based cohort study. SETTING: A total of 106 French maternity units (146 781 deliveries, December 2004 to November 2006). POPULATION: All women with PPH (n = 9365). METHODS: Description of the rate of red blood cell (RBC) transfusion in PPH overall and compared with transfusion guidelines. MAIN OUTCOME MEASURES: Transfusion practices and postpartum anemia by mode of delivery and cause of PPH in women given RBCs within 12 h after PPH. RESULTS: A total of 701 women received RBCs (0.48 ± 0.04% of all women and 7.5 ± 0.5% of women with PPH). Half the women with clinical PPH and hemoglobin lower than 7.0 g/dL received no RBCs. In the group with clinical PPH and transfusion within 12 h (n = 426), operative vaginal delivery was associated with a larger maximal hemoglobin drop, more frequent administration of fresh-frozen plasma (FFP) and pro-hemostatic agents [odds ratio (OR) 3.54, 95% confidence interval (95% CI) 1.12-11.18], transfusion of larger volumes of RBCs and FFP, a higher rate of massive RBCs transfusion (OR 5.22, 95% CI 2.12-12.82), and more frequent use of conservative surgery (OR 3.2, 95% CI 1.34-7.76), compared with spontaneous vaginal delivery. CONCLUSIONS: The RBC transfusion for PPH was not given in a large proportion of women with very low hemoglobin levels despite guidelines to the contrary. Operative vaginal delivery is characterized by higher blood loss and more transfusions than spontaneous vaginal delivery.
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Submitted on : Wednesday, January 1, 2014 - 7:00:25 AM
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Marie-Pierre Bonnet, Catherine Deneux-Tharaux, Corinne Dupont, Rene-Charles Rudigoz, Marie-Helene Bouvier-Colle. Transfusion practices in postpartum hemorrhage: a population-based study.: Transfusion in Postpartum Haemorrhage. Acta Obstetricia et Gynecologica Scandinavica, Wiley, 2013, 92 (4), pp.404-13. ⟨10.1111/aogs.12063⟩. ⟨inserm-00809169⟩

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