The use of blood transfusions in the obstetric unit of an academic hospital in South Africa

Basu, Jayati Kusari; Hartford, Leila; Nzama, Noziphiwo; Dayal, Chandni; Naidoo, Bianca; Chuene, Mabua; Itzikowitz, Gina; Alphen-Stahl, Jonathan Van; Segooa, Mashegela; Schehle, Michelle; Govender, Preshanthi

doi:10.1080/10158782.2012.11441478

Cited by 2 publications

(2 citation statements)

References 16 publications

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“…The proportion in the mifepristone group (4.3%) was comparable to the 4% rate reported previously for all deliveries in a South African hospital in 2010 [38], but higher than other studies on second-trimester medical abortion, which vary from 0.7–3% [16, 23, 24]. The transfusion threshold is context- and provider-dependent, and most women having transfusions had a documented drop in hemoglobin with signs and/or symptoms of anemia.…”

Section: Discussionsupporting

confidence: 83%

Clinical Outcomes and Women’s Experiences before and after the Introduction of Mifepristone into Second-Trimester Medical Abortion Services in South Africa

et al. 2016

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ObjectiveTo document clinical outcomes and women’s experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only.MethodsRepeated cross-sectional observational studies documented service delivery and experiences of women undergoing second-trimester medical abortion in public sector hospitals in the Western Cape, South Africa. Women recruited to the study in 2008 (n = 84) and 2010 (n = 58) received misoprostol only. Those recruited in 2014 (n = 208) received mifepristone and misoprostol. Consenting women were interviewed during hospitalization by study fieldworkers with respect to socio-demographic information, reproductive history, and their experiences with the abortion. Clinical details were extracted from medical charts following discharge. Telephone follow-up interviews to record delayed complications were conducted 2–4 weeks after discharge for the 2014 cohort.ResultsThe 2014 cohort received 200 mg mifepristone, which was self-administered 24–48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the earlier cohorts. Women received subsequent doses of misoprostol 400 mcg orally every 3–4 hours until fetal expulsion. Thereafter, uterine evacuation of placental tissue was performed as needed. With one exception, all women in all cohorts expelled the fetus. Median time-to-fetal expulsion was reduced to 8.0 hours from 14.5 hours (p<0.001) in the mifepristone compared to the 2010 misoprostol-only cohort (time of fetal expulsion was not recorded in 2008). Uterine evacuation of placental tissue using curettage or vacuum aspiration was more often performed (76% vs. 58%, p<0.001) for those receiving mifepristone; major complication rates were unchanged. Hospitalization duration and extreme pain levels were reduced (p<0.001), but side effects of medication were similar or more common for the mifepristone cohort. Overall satisfaction remained unchanged (95% vs. 91%), while other acceptability measures were higher (p<0.001) for the mifepristone compared to the misoprostol-only cohorts.ConclusionThe introduction of a combined mifepristone-misoprostol regimen into public sector second-trimester medical abortion services in South Africa has been successful with shorter time-to-abortion events, less extreme pain and greater acceptability for women. High rates of uterine evacuation for placental tissue need to be addressed.

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Section: Discussionsupporting

confidence: 83%

Clinical Outcomes and Women’s Experiences before and after the Introduction of Mifepristone into Second-Trimester Medical Abortion Services in South Africa

et al. 2016

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“…Different studies across the world had reported the incidence of transfusion of blood or blood component in obstetric [3][4][5][6][7][8][9] hemorrhage varied from 1.4-6.8%. Incidence of transfusion of blood or components in the present analysis (4.02%) was in agreement with the above results.…”

Section: Discussionmentioning

confidence: 99%

Study of Indications of Blood Components in Obstetric Hemorrhage at a Tertiary Care Centre in South India

Sushama

Usha²,

Jose

2020

Global Journal for Research Analysis

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Blood transfusion is an essential part of management of many indications in obstetrics. A prospective study was conducted with objectives to portray the indications, mean usage and inter-relationship of blood components in obstetric hemorrhages. Out of total 10063 obstetric patients, 405 patients (N) required transfusion (4.02% incidence). Detailed clinical and transfusion history and management was recorded and analyzed. A total of 1386 units (55% packed red cells, 19% platelet concentrates, 24% fresh frozen plasma and 2% cryoprecipitate) of blood components were used to treat obstetric hemorrhage cases. Most common indication for blood transfusion was observed to be uterine atony (37%) followed by abruption (18.5%) and genital tract trauma during delivery (14.8%) and other causes. A strong positive correlation of PRC usage was observed with the number of units (usage) of PC, FFP and Cryoprecipitate units transfused to the patients with obstetric hemorrhage (P<0.00001; P<0.00001 and P=0.002786 respectively). Most common indication for transfusion of blood components was uterine atony. Maximum mean usages of packed red cells, platelet concentrate and fresh frozen plasma were for placenta accreta/percreta/increta.

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The use of blood transfusions in the obstetric unit of an academic hospital in South Africa

Cited by 2 publications

References 16 publications

Clinical Outcomes and Women’s Experiences before and after the Introduction of Mifepristone into Second-Trimester Medical Abortion Services in South Africa

Clinical Outcomes and Women’s Experiences before and after the Introduction of Mifepristone into Second-Trimester Medical Abortion Services in South Africa

Study of Indications of Blood Components in Obstetric Hemorrhage at a Tertiary Care Centre in South India

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