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Postpartum Hemorrhage and Transfusion of Blood and Blood Components

Jansen, A J. G. MSc*; van Rhenen, D J. MD, PhD†; Steegers, E A. P. MD, PhD‡; Duvekot, J J. MD, PhD§

Obstetrical & Gynecological Survey: October 2005 - Volume 60 - Issue 10 - pp 663-671
CME Program: CATEGORY 1 CME REVIEW ARTICLES 27, 28, AND 29: CME Review Article 27

Postpartum hemorrhage (PPH) is one of the top 5 causes of maternal mortality in developed and developing countries. The incidence of PPH is 40% after vaginal delivery and 30% after cesarean section. Criteria for PPH are based on the amount of blood loss. In clinical obstetrics, exact measurement of blood loss is often difficult. The most important treatment of PPH is red blood cell (RBC) transfusion. In the past few years, increasing concern has arisen about this treatment. Despite the introduction of several new guidelines, transfusion criteria still vary widely between clinicians. The decision whether to prescribe RBC transfusion is mostly based on postpartum hemoglobin (Hb) values. RBC transfusion should be aimed to reduce morbidity and especially to improve health-related quality of life (HRQoL). In this review, etiology, epidemiology, treatment, and prevention of postpartum hemorrhage are described. Special attention is given to the role of RBC transfusion in the treatment of PPH and the effects of RBC transfusion on HRQoL.

Target Audience: Obstetricians & Gynecologists, Family Physicians.

Learning Objectives. After completion of this article, the reader should be able to summarize the new guidelines related to transfusion criteria, explain the importance of reducing morbidity related to improving quality of life issues, and list infectious and noninfectious complications of a red blood cell transfusion.

*PhD Student, Sanquin Blood Bank South West Region, Rotterdam, The Netherlands; †Director, Sanquin Blood Bank South West Region, Rotterdam, The Netherlands; and Professor, Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; ‡Professor, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; and §Gynecologist/Obstetrician, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

Chief Editor’s Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credit hours can be earned in 2005. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.

Wolters Kluwer Health has identified and resolved all faculty conflicts of interest regarding this educational activity.

Reprint requests to: J. J. Duvekot, MD, PhD, Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Room SK 4156, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands. E-mail: j.j.duvekot@erasmusmc.nl.

© 2005 Lippincott Williams & Wilkins, Inc.