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. 2019 Dec;126(13):1577-1586.
doi: 10.1111/1471-0528.15927. Epub 2019 Sep 23.

Massive blood transfusion in relation to delivery: incidence, trends and risk factors: a population-based cohort study

L Thurn  1 , A Wikman  2 , M Westgren  1 , P G Lindqvist  3   4
Affiliations

Massive blood transfusion in relation to delivery: incidence, trends and risk factors: a population-based cohort study

L Thurn et al. BJOG. 2019 Dec.

Abstract

Objective: To estimate incidence, trends over time, and risk factors for massive blood transfusions in obstetric patients. A secondary aim was to evaluate transfusion ratios in relation to massive transfusion.

Design: Population-based cohort.

Setting: Five hospitals, in the Stockholm County, Sweden, from 1990 to 2011.

Population: All women that gave birth in Stockholm county, Sweden, and who received blood transfusions postpartum between 1990 and 2011.

Methods: Data on pregnancies and deliveries from the Swedish National Medical Birth Registry was cross-linked to the Stockholm transfusion database. Massive blood transfusion was defined as the transfusion of ≥10 units of red blood cells from partus through the next day.

Main outcome measures: Main primary outcome was massive blood transfusion postpartum.

Results: Our cohort comprised 517 874 deliveries. Massive blood transfusion occurred in 277 women, for an incidence of 5.3 per 10 000 deliveries, and increased by 30% (P < 0.001) between the first and the second half of the study period. Major risk factors apparent before delivery were abnormal placentation (odds ratio [OR] 41; 95% CI 29.3-58.1), pre-eclampsia/placental abruption (OR 4; 95% CI 2.8-5.6), and previous caesarean delivery (OR 4; 95% CI 3.1-6.0). Risk factors at time of delivery were uterine rupture, atonic uterus, and caesarean delivery (OR 38, 17, and 3, respectively).

Conclusion: We found an increasing trend in the postpartum rate of massive transfusion. Women with abnormal placentation were found to have the highest increased risk. Improved antenatal awareness of these women at risk might improve management and reduce the rate of massive transfusion.

Tweetable abstract: Risk of massive blood transfusion in obstetric patients increases with placental complications and prior caesarean section.

Keywords: Massive blood transfusion; placenta accreta; placenta accreta spectrum; placenta praevia; placental complications; postpartum haemorrhage; previous caesarean section; risk factors.

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References

    1. World Health Organization. Managing Complications in Pregnancy and Childbirth. Geneva: WHO; 2000.
    1. Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367:1066-74.
    1. Malone DL, Hess JR, Fingerhut A. Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol. J Trauma 2006;60(6 Suppl):S91-6.
    1. British Committee for Standards in Haematology, Stainsby D, MacLennan S, Thomas D, Isaac J, Hamilton PJ. Guidelines on the management of massive blood loss. Br J Haematol 2006;135:634-41.
    1. Mitra B, Cameron PA, Gruen RL, Mori A, Fitzgerald M, Street A. The definition of massive transfusion in trauma: a critical variable in examining evidence for resuscitation. Eur J Emerg Med 2011;18:137-42.

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