The authors declare that they have no conflicts of interests.
Main Research Article
Transfusion practices in postpartum hemorrhage: a population-based study
Article first published online: 16 JAN 2013
© 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology
Acta Obstetricia et Gynecologica Scandinavica
Special Issue: Abnormally invasive placenta - AIP
Volume 92, Issue 4, pages 404–413, April 2013
How to Cite
Transfusion practices in postpartum hemorrhage: a population-based study. Acta Obstet Gynecol Scand 2013;92:404–413., , , , .
- Issue published online: 21 MAR 2013
- Article first published online: 16 JAN 2013
- Accepted manuscript online: 5 DEC 2012 08:54AM EST
- Manuscript Accepted: 26 NOV 2012
- Manuscript Received: 10 APR 2012
- French Ministry of Health. Grant Number: 27–35
- postpartum hemorrhage;
- blood transfusion;
- postpartum anemia
To describe transfusion practices and anemia in women with postpartum hemorrhage (PPH), according to the clinical context.
Population-based cohort study.
A total of 106 French maternity units (146 781 deliveries, December 2004 to November 2006).
All women with PPH (n = 9365).
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.
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.
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.