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

Abstract

Purpose Peripartum 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. Methods Using 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. Results PPH 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. Conclusion The 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.

Evaluation of blood transfusion rate in obstetric patients

“…Anemia during pregnancy is defined as the hemoglobin value below 11 g/dL in each trimester, according to the World Health Organization (WHO) [15]. Anemia is an important risk factor in postpartum bleeding [3]. This suggest that it is associated with unfollowed pregnancies that do not attend pregnancy follow-ups and do not use iron supplements.…”

“…This suggest that it is associated with unfollowed pregnancies that do not attend pregnancy follow-ups and do not use iron supplements. Current Swiss guidelines recommend that hemoglobin levels should be screened regularly at least once every trimester, and iron levels should be screened in the first trimester [3]. Various algorithms have been emphasized in postpartum hemorrhage, especially in massive bleeding, although the benefits of fibrinogen and tranexamic acid are shown, more studies are needed [16].…”

“…Although the blood transfusion rate is between 0.16% and 6% in obstetrics, transfusion rates vary among countries, hospitals and doctors due to different practices [2]. Several studies in the literature have shown that the use of restrictive erythrocyte suspension (ES) transfusions has better clinical outcome benefits for patients, including reduced morbidity and mortality, shorter hospital stay, and reduced risk of intensive care unit admission [3]. Recently, there was a tendency to decrease the use of blood transfusion in obstetric practice.…”

Effects of perioperative red blood cell transfusion on systemic immune indicators and postoperative recovery in patients undergoing cesarean section: A propensity score matching analysis

“…Blood transfusion is the most common method for the clinical treatment of patients with obstetric hemorrhage. It effectively solve the patient's anemia caused by excessive blood loss, helps maintain blood volume and blood pressure, exerts a certain preventive effect on patients with shock, and improves the prognosis of patients (11,12). However, a large number of clinical practices have found that after patients with obstetric hemorrhage receive a large transfusion of blood, although their life and safety are guaranteed, they also experience certain side effects, mainly manifested as abnormal blood coagulation (13).…”

Factors Contributing to Red Blood Cells Crossmatch and Transfusion among Obstetrics Patients in a Single Tertiary Hospital

“…Similar findings were also noted by Zdanowicz et al, which showed that RBC transfusion was more frequent in instrumental assisted delivery than Caesarean section or SVD. 26 The requirement for RBC transfusion in instrumental assisted delivery may be attributed to complications of these procedures such as perineal or cervical tear. 27 The obstetrics procedure with protective findings to the RBC transfusion in our study was Caesarean section; those who underwent this procedure had a 62.3% less chance to receive RBC transfusion than those who underwent normal SVD.…”