Blood transfusion and caesarean section in a developing country

Abstract

Our objective was to review blood transfusion practices during caesarean section in a developing country. An audit of 463 consecutive caesarean sections and blood transfusions over a 3-year period (2000 - 2002) was undertaken. The data were collected from the records department in a pre-designed proforma and analysed, using EPI - info Statistical Software version 6. A total of 117 out of 463 (25.2%) caesarean section cases were transfused. The rate of blood transfusion for the various indications were as follows: malpresentation (excluding breech), four out of six (66.7%); placenta praevia, 28 out of 49 (59.1%); uterine rupture, five out of nine (55.6%); breech delivery, eight out of 25 (32%); obstructed labour, 35 out of 124 (28.2%); precious baby, one out of four (25%); previous caesarean section, 24 out of 141 (17.0%); severe pre-eclampsia, five out of 45 (11.1%); fetal distress, three out of 28 (10.7%); and others, three out of 29 (10.3%). A total of 78 (67.2%) of caesarean section cases were emergency. A blood transfusion rate of 25.2% during caesarean section is high. The indications for the caesarean section, preoperative anaemia and quantity of blood loss during caesarean section were significant risk factor for blood transfusion. Efforts should be made to reduce the blood transfusion without increasing maternal morbidity and mortality. This is very important because of rising HIV infection in developing country and blood-borne disease.

Blood loss and risk of blood transfusion in patients undergoing caesarean section

“…They concluded that, in the absence of significant risk factors, routine blood typing and screening at admission for caesarean section did not enhance patient care and should be eliminated. Increased blood loss and transfusion risk in cases of anaemia was reported in other studies 15,16 . The role of anaemia as represented by pre-operative haemoglobin level was also found to be not significantly associated with increased blood loss risk in this study (P >0.05).…”

“…Preeclampsia/-eclampsia 15,16 and acute fatty liver of pregnancy 17 were associated with higher incidence of blood loss and increased risk of blood transfusion. Hypertensive disorders are common and form one of the deadly triad along with hemorrhage and infection that results in much of the maternal morbidity and mortality related to pregnancy 18 .…”

Blood transfusion practices among delivery cases: A retrospective study of two years

“…Overall blood transfusion incidence is lower in planned surgery (1.58) as compared to emergency surgery (3.58) and unforeseen emergencies occurring during normal delivery (2.82). A Nigerian study 13 had indicated a very high incidence of transfusion (25%), which was probably related to preoperative anemia. The mode of delivery has some influence on blood transfusion.…”

Influence of placental position on obstetric morbidity in placenta previa

“…A study from Nigeria reported that the necessity of transfusion was felt in 59.1 % cases of placenta previa. 9 Rumina T et al 10 studied the need for blood transfusion in 77 subjects with placenta previa in a teaching hospital in Karachi, Pakistan. A total of 177 (mean 2.3) transfusions were received by 59 (76.6%) patients.…”