Red blood cell transfusion in obstetrics and its implication for patient blood management: a retrospective analysis in Switzerland from 1998 to 2016

Abstract

Purpose: Peripartum hemorrhage (PPH) remains one of the main causes of maternal mortality worldwide. Treatment includes administration of packed red blood cells (RBC) in severe cases and patient blood management (PBM) may reduce it significantly. In our study, we wanted to retrospectively assess red blood cell administration in PPH to evaluate the impact of PBM in Switzerland.

Methods: Using data from the Swiss obstetric hospital registry (Arbeitsgemeinschaft Schweizer Frauenkliniken, ASF), we included patients with deliveries from 1998 to 2016. We examined available obstetric data as well as blood loss and RBC administration in the acute and subacute peripartal phase. We categorized data into two time intervals: 1998-2011 and 2012-2016, as new PPH guidelines in Switzerland were established in 2012.

Results: PPH incidence increased between 1998 and 2016 significantly. The number of vaginal instrumental deliveries and cesarean sections increased as well. Administration of three or more RBC units, as defined in the ASF registry, in the acute and subacute phase in Switzerland has decreased after 2012. Conversely, we saw an increase in the administration of one to two RBC units in the acute and subacute phase. Nevertheless, overall RBC administration has been decreasing from 1998 to 2016.

Conclusion: The increase of patients obtaining one or two units of RBC for PPH suggests that there may be a potential for effective implication of PBM in obstetrics. Reduction of RBC transfusion in the context of PPH may not only decrease maternal morbidity, but decrease economic costs as well.

Keywords: Patient blood management; Peripartum hemorrhage; Red blood cell; Transfusion.

Fig. 1

a Total number of deliveries from 1998–2016; b deliveries from 1998–2016 according to delivery mode (SVD spontaneous vaginal delivery, Instrumental VD instrumental vaginal delivery, CS Cesarean section)

Fig. 2

a RBC administration in the acute phase from 1998–2016 across all deliveries; b overall RBC administration in the acute phase from 1998–2016 across individual delivery modes (RBC red blood cell, SVD spontaneous vaginal delivery, Instrumental VD instrumental vaginal delivery, CS Cesarean section)

Fig. 3

a RBC administration in the subacute phase from 1998–2016 across all deliveries; b overall RBC administration in the subacute phase from 1998–2016 across individual delivery modes (RBC red blood cell, SVD spontaneous vaginal delivery, Instrumental VD instrumental vaginal delivery, CS Cesarean section)