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Keywords:

  • Obstetrics;
  • practices;
  • postpartum hemorrhage;
  • blood transfusion;
  • postpartum anemia

Abstract

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 RBCs 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.