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Blood Transfusion and Caesarean section
Author(s) -
Maxwell Chris N.
Publication year - 1989
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1989.tb01699.x
Subject(s) - medicine , caesarean section , blood transfusion , obstetrics , pregnancy , surgery , genetics , biology
EDITORIAL COMMENT: The AIDS epidemic has resulted in a reexamination of the need for blood transfusion and many patients express the wish to avoid a blood transfusion if possible. It is reasonably easy to reduce the incidence of blood transfusion for postpartum anaemia in a patient who is not bleeding — our criterion is a haemoglobin value of less than 8 g/dl whereas previously it was a value of less than 10 g/dl. This paper presents useful information concerning the incidence of urgent blood transfusion at Caesarean section, and argues that preoperative cross‐matching of blood is necessary only in patients with placenta praevia, abruptio placentae and severe preeclampsia. It may interest readers to note the following incidence of blood transfusion associated with Caesarean section at the Mercy Maternity Hospital, Melbourne: 13.7% of 1,214 Caesareans (1971–1974), 10.8% of 1,513 (1975–1977), 8.2% of 1,906 (1978–1980), 8.3% of 2,305 (1981–1983) and5.7% of 2,530 (1984–1986). We should remember that acute blood loss at Caesarean section cannot always be anticipated. If the author's recommendation for blood group and antibody screening alone for most patients is to be taken, the anaesthetist must always have an intravenous line in place, volume expanding fluids available and be prepared to give uncross‐matched blood of appropriate group and Rh type if the need arises. Summary: A clinical audit of 1,000 consecutive Caesarean sections at the Royal Women's Hospital indicated that 9.4% of patients required blood transfusion. Urgent blood transfusion was required in 53% of the 33 patients requiring Caesarean section because of placenta praevia, 43% of the 23 with accidental haemorrhage, 11% of the 36 with severe preeclampsia, but in only 2.3% of the remaining 908 patients. Blood was cross‐matched preoperatively in 47.7% of patients and 90% of this blood was either not administered or given as a delayed nonurgent procedure. It is suggested that routine preoperative cross‐matching of blood could be replaced by a blood type and antibody screening procedure for Caesarean sections being performed for those indications associated with low risk of blood transfusion requirement.