Open AccessTransfusion practices in postpartum hemorrhage: a population‐based study
Author(s) -
Bonnet MariePierre,
DeneuxTharaux Catherine,
Dupont Corinne,
Rudigoz ReneCharles,
BouvierColle MarieHelene
Publication year - 2013
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12063
Subject(s) - medicine , odds ratio , blood transfusion , obstetrics , context (archaeology) , anemia , postpartum bleeding , vaginal delivery , confidence interval , population , fresh frozen plasma , cohort study , pregnancy , surgery , gynecology , platelet , paleontology , genetics , environmental health , biology
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 RBC s 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.