Blood Transfusion During Pregnancy, Birth, and the Postnatal Period

Patterson, Jillian A. BScAdv(Hons), MBiostat; Roberts, Christine L. MBBS, DrPH; Bowen, Jennifer R. MBBS (Hons), FRACP; Irving, David O. MSc, PhD; Isbister, James P. BSc(Med) Hons, MB BS Hons; Morris, Jonathan M. MBChB, PhD; Ford, Jane B. BA(Hons), PhD

doi: 10.1097/AOG.0000000000000054
Contents: Original Research

OBJECTIVES: To identify risk factors for transfusion and trends in transfusion rates across pregnancy and the postnatal period.

METHODS: Linked hospital and birth data on all births in hospitals in New South Wales, Australia, between 2001 and 2010 were used to identify blood transfusions for women during pregnancy, at birth, and in the 6 weeks postpartum. Poisson regression was used to identify risk factors for red cell transfusion in the birth admission. Separate models were fitted for cesarean and vaginal births.

RESULTS: Between 2001 and 2010, there were 12,147 transfusions across 891,914 pregnancies, with a transfusion rate of 1.4%. The transfusion rate increased steadily from 1.2% in 2001 to 1.6% in 2010. The majority of transfusions (91%) occurred during the birth admission, and 81% of these transfusions were associated with a diagnosis of hemorrhage. Women with bleeding or platelet disorders (vaginal: number transfused 529, relative risk [RR] 7.8, 99% confidence interval [CI] 6.9–8.7, cesarean: n=592, RR 8.7, CI 7.7–9.7) and placenta previa: (vaginal n=73, RR 4.6, CI 3.4–6.3, cesarean: n=875, RR 5.7, CI 5.1–6.4) were at highest risk of transfusion. Among vaginal births, increased risk was evident for forceps (n=1,036, RR 2.8, CI 2.5–3.0) or vacuum births (n=1,073, RR 1.9, CI 1.7–2.0) compared with nonoperative births.

CONCLUSIONS: Rates of obstetric blood product transfusion have increased by 33% since 2001, with the majority of this associated with hemorrhage. Women with bleeding or platelet disorders and placenta previa are at increased risk of transfusion and should be treated accordingly.

LEVEL OF EVIDENCE: II

Obstetric blood product transfusion rates have increased by 33% since 2001, with the majority during the birth admission associated with hemorrhage.

Kolling Institute, University of Sydney, the Royal North Shore Hospital, the University of Sydney, and the Australian Red Cross Blood Service, Sydney, New South Wales, Australia.

Corresponding author: Jillian A. Patterson, BScAdv(Hons), MBiostat, Clinical & Population Perinatal Health Research, c/o University Department of O&G, Building 52, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia; e-mail: jillian.patterson@sydney.edu.au.

Supported by a Partnership Grant from the Australian National Health and Medical Research Council NHMRC (#1027262), the Australian Red Cross, and the NSW Clinical Excellence Commission. Christine L. Roberts is supported by a NHMRC Senior Research Fellowship (#1021025). Jane B. Ford is supported by an ARC Future Fellowship (#120100069).

The authors thank the NSW Ministry of Health for access to the population health data and the NSW Centre for Health Record Linkage for linking the data sets.

An earlier version of these findings was presented in poster form at the Society for Pediatric and Perinatal Epidemiologic Research 26th Annual Meeting, June 17–18, 2013, Boston, Massachusetts.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.