Incidence, trends and risk factors for obstetric massive blood transfusion in China from 2012 to 2019: an observational study

Xie, Yanxia; Liang, Juan; Mu, Yi; Liu, Zheng; Wang, Yanping; Dai, Li; Li, Xiaohong; Li, Qi; Li, Mingrong; Chen, Peiran; Zhu, Junwu; Wang, Xiaodong

doi:10.1136/bmjopen-2020-047983

Cited by 7 publications

(8 citation statements)

References 40 publications

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“…Additionally, we did two sensitivity analyses. First, because the condition of “massive transfusion of blood or red cells” was expected to be more susceptible to maternal anemia than the other identifying indicators of severe maternal outcomes, 23 we excluded the condition of “massive transfusion of blood or red cells” from severe maternal outcomes, and the outcome was restricted to the remaining 23 conditions representative of non-massive transfusion severe maternal outcomes. Second, we removed cases of hemorrhagic disorders from the adjusted Poisson regression models considering the link between hemorrhagic disorders and anemia.…”

Section: Methodsmentioning

confidence: 99%

The Association Between Severity of Anemia During Pregnancy and Severe Maternal Outcomes: A Retrospective Cohort Study

Li¹,

Fang²,

Luo³

et al. 2022

CLEP

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Purpose Anemia is a worldwide common condition during pregnancy, conferring a number of health risks to mothers. However, very little is known about the association between severity of anemia and severe maternal outcomes. This study aimed to assess the association between severity of anemia during pregnancy and the risk of severe maternal outcomes. Patients and Methods This retrospective cohort study was based on data from China’s National Maternal Near Miss Surveillance System for the period 2017–2018, which included 18 hospitals in southern China. Pregnant women admitted for delivery were divided into 4 groups based on severity of anemia during pregnancy: no anemia, mild anemia, moderate anemia, and severe anemia groups. Severe maternal outcomes were a composite of life-threatening conditions (ie, organ dysfunction) as defined by the WHO criteria, occurring at any time after admission until discharge or death. Modified Poisson regression analyses and propensity score-weighted regression analyses were used to estimate the relative risks (RRs) and 95% confidence intervals (CIs) of severe maternal outcomes among women with anemia of varying severity during pregnancy. Results The incidence of severe maternal outcomes was 0.3% (417/138,556) in total, and the rates were 0.1% (85/99,755), 0.2% (30/18,502), 1.2% (234/19,697) and 11.3% (68/602) in no anemia, mild anemia, moderate anemia and severe anemia group, respectively. Compared with no anemia, the adjusted RR for severe maternal outcomes was 4.19 (95% CI, 3.20–5.50) in moderate anemia group and 22.12 (95% CI, 15.43–31.69) in severe anemia group; the weighted RR was 1.01 (95% CI, 1.01–1.01) in moderate anemia group and 1.11 (95% CI, 1.07–1.14) in severe anemia group. Conclusion Moderate to severe anemia during pregnancy was independently associated with an increased risk of severe maternal outcomes. Maternal health care providers and pregnant women themselves should give more attention to the prevention and treatment of anemia during pregnancy, especially moderate to severe anemia.

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Section: Methodsmentioning

confidence: 99%

The Association Between Severity of Anemia During Pregnancy and Severe Maternal Outcomes: A Retrospective Cohort Study

Li¹,

Fang²,

Luo³

et al. 2022

CLEP

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“…The American College of Obstetricians and Gynecologists (ACOG) defines PPH as 1000 ml or more of blood loss or loss of blood accompanied by signs and symptoms of hypovolemia within 24 h of delivery [4]. The incidence of PPH and rates of massive blood transfusions (MBT) are rising despite efforts in reducing the most preventable contributor of maternal morbidity and mortality [5]. Uterine atony is the most common etiology for all PPH, and recent studies demonstrate that atony is also the most common etiology of severe hemorrhage and MBT [1 ▪ ,2 ▪ ,3–6].…”

Section: Epidemiology and Incidencementioning

confidence: 99%

“…The incidence of PPH and rates of massive blood transfusions (MBT) are rising despite efforts in reducing the most preventable contributor of maternal morbidity and mortality [5]. Uterine atony is the most common etiology for all PPH, and recent studies demonstrate that atony is also the most common etiology of severe hemorrhage and MBT [1 ▪ ,2 ▪ ,3–6].…”

Section: Epidemiology and Incidencementioning

confidence: 99%

“…MBT is defined by the WHO multicountry survey as transfusion of ≳5 units of red blood cells or ≳1000 ml of whole blood [5]. In one large observational study of 11 667 406 women in China, MBT showed an increasing trend year-over-year from 2012 to 2019 ( P for trend <0.0001), with an overall incidence of 23.68 per 10 000 births.…”

Section: Epidemiology and Incidencementioning

confidence: 99%

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Uterine atony

Miller

Ansari

2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewPostpartum hemorrhage (PPH) is the leading preventable cause of maternal morbidity and mortality worldwide. Uterine atony is identified as the underlying etiology in up to 80% of PPH. This serves as a contemporary review of the epidemiology, risk factors, pathophysiology, and treatment of uterine atony.Recent findingsRates of postpartum hemorrhage continue to rise worldwide with the largest fraction attributed to uterine atony. A simple 0–10 numerical rating score for uterine tone was recently validated for use during cesarean delivery and may allow for more standardized assessment in clinical and research settings. The optimal prophylactic dose of oxytocin differs depending on the patient population, but less than 5 units and as low as a fraction of one unit is needed for PPH prevention, with an increased requirements within that range for cesarean birth, those on magnesium, and advanced maternal age. Carbetocin is an appropriate alternative to oxytocin. Misoprostol shows limited to no efficacy for uterine atony in recent studies. Several uncontrolled case studies demonstrate novel mechanical and surgical interventions for treating uterine atony.SummaryThere is a critical, unmet need for contemporary, controlled studies to address the increasing threat of atonic PPH.

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“…In 2016, the overall cesarean section in China ranked among the top in the world, about 41.1%, and the proportion of scarred uterus mothers increased from 9.8-17.7% between 2012 and 2016. Excessive cesarean section rates pose certain threats to maternal and fetal health (Xie, et al, 2021). No matter the rst cesarean section or the second cesarean section, there is the possibility of massive bleeding.…”

mentioning

confidence: 99%

Risk Factors of Blood Transfusion During Cesarean Section

Zhang

2022

Preprint

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Backgroud: this work was to explore the risk factors of postpartum hemorrhage among puerperae in XX Hospital, and to analyze the influence of high risk factors of postpartum hemorrhage. Methods: the electronic medical record system was adopted to include 220 cases, and 78 puerperae were screened into the blood transfusion group. The clinical indicators of puerperae were analyzed, and the preoperative liver function and renal function were analyzed. The indexes of blood coagulation status and blood routine indexes of puerperae after blood transfusion before blood transfusion were analyzed. Risk factors for blood transfusion during cesarean section were analyzed using a machine learning model. Results: prenatal examination and diagnosis showed that the abnormal placenta accounted for 28.21%; the abnormal amniotic fluid accounted for 7.69%; the umbilical cord around neck accounted for 21.79%; threatened premature birth accounted for 24.36%; scarred uterus accounted for 24.36%; preeclampsia accounted for 20.52%; and anemia accounted for 30.77%. The mean prenatal ALT of liver function index was 20.21, the mean value of AST was 21.29. The mean value of blood urea of renal function index was 4.59, and the mean value of serum creatinine was 46.27. The indexes of blood coagulation status after blood transfusion, RBC, Hct, Plt, PT, APTT, Fbg, and D-D, were significantly different from those before blood transfusion (P < 0.05). The blood routine before blood transfusion indicated that Hb, RBC, and Hct were significantly different from those after blood transfusion (P < 0.05). Conclusion: risk factors of blood transfusion during cesarean section included placenta accreta, placental abruption, placental adhesion, polyhydramnios, pregnancy-induced hypertension, uterine atony, uterine fibroids, cesarean section, and dangerous placenta previa. Risk factors for blood transfusion during cesarean section may gradually decrease with increasing gestational age.

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Incidence, trends and risk factors for obstetric massive blood transfusion in China from 2012 to 2019: an observational study

Cited by 7 publications

References 40 publications

The Association Between Severity of Anemia During Pregnancy and Severe Maternal Outcomes: A Retrospective Cohort Study

The Association Between Severity of Anemia During Pregnancy and Severe Maternal Outcomes: A Retrospective Cohort Study

Uterine atony

Risk Factors of Blood Transfusion During Cesarean Section

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