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Massive Blood Transfusion During Hospitalization for Delivery in New York State, 1998–2007

Mhyre, Jill M. MD; Shilkrut, Alexander MD; Kuklina, Elena V. MD, PhD; Callaghan, William M. MD, MPH; Creanga, Andreea A. MD, PhD; Kaminsky, Sari MD; Bateman, Brian T. MD, MSc

doi: 10.1097/AOG.0000000000000021
Contents: Original Research

OBJECTIVE: To define the frequency, risk factors, and outcomes of massive transfusion in obstetrics.

METHODS: The State Inpatient Dataset for New York (1998–2007) was used to identify all delivery hospitalizations for hospitals that reported at least one delivery-related transfusion per year. Multivariable logistic regression analysis was performed to examine the relationship between maternal age, race, and relevant clinical variables and the risk of massive blood transfusion defined as 10 or more units of blood recorded.

RESULTS: Massive blood transfusion complicated 6 of every 10,000 deliveries with cases observed even in the smallest facilities. Risk factors with the strongest independent associations with massive blood transfusion included abnormal placentation (1.6/10,000 deliveries, adjusted odds ratio [OR] 18.5, 95% confidence interval [CI] 14.7–23.3), placental abruption (1.0/10,000, adjusted OR 14.6, 95% CI 11.2–19.0), severe preeclampsia (0.8/10,000, adjusted OR 10.4, 95% CI 7.7–14.2), and intrauterine fetal demise (0.7/10,000, adjusted OR 5.5, 95% CI 3.9–7.8). The most common etiologies of massive blood transfusion were abnormal placentation (26.6% of cases), uterine atony (21.2%), placental abruption (16.7%), and postpartum hemorrhage associated with coagulopathy (15.0%). A disproportionate number of women who received a massive blood transfusion experienced severe morbidity including renal failure, acute respiratory distress syndrome, sepsis, and in-hospital death.

CONCLUSION: Massive blood transfusion was infrequent, regardless of facility size. In the presence of known risk for receipt of massive blood transfusion, women should be informed of this possibility, should deliver in a well-resourced facility if possible, and should receive appropriate blood product preparation and venous access in advance of delivery.


Massive blood transfusion occurs in approximately 6 of every 10,000 deliveries; strongest risk factors include placental abruption, abnormal placentation, intrauterine fetal demise, and severe preeclampsia.

Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan; the Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York; the Division for Heart Disease and Stroke Prevention and the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; and the Department of Anesthesiology, Critical Care, & Pain Medicine, Massachusetts General Hospital, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Corresponding author: Jill M. Mhyre, MD, Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 515, Little Rock, AR 72205; e-mail:

Presented at the Society of Obstetric Anesthesia and Perinatology meeting, May 2–5, 2012, Monterey, California.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.