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A retrospective review of the potential impact of Body Mass Index on the incidence and degree of blood transfusion
Abstract Number: F-6
Abstract Type: Original Research
The rate of Cesarean section has been increasing steadily the last few decades, along with an increased incidence of obstetric hemorrhage, [1, 2] which is a significant cause of maternal mortality.  There are a number of risk factors for obstetric hemorrhage, with prior C-section being an important one. High body mass index (BMI) is an independent risk factor for delivery by C-section,  so may correlate with hemorrhage and the need for blood transfusion. To investigate the impact of BMI on blood transfusion practices we report the preliminary results of a retrospective review of blood loss and respective blood transfusion for C-section patients and if any association exists with BMI of those patients.
Methods: After IRB approval, retrospective review of transfusion records of parturients who had a Cesarean section delivery and concomitant blood transfusion perioperatively (24 hours from C-section) was collected. Chart review included demographics, medical comorbidities, pre-operative Hemoglobin values, vitals, reason for C-section, intra-operative variables of transfusion, surgery and anesthetic components as well as postoperative outcomes. Results: When dividing the data into 3 blood loss groups based on recorded estimated blood loss (EBL); Group 1) 500-1000ml 2) 1000-2000ml and 3) 2000-4000ml, preliminary analysis showed no significant difference (p >0.05) in BMI comparing the groups, the average BMI being respectively 34.9, 37.3 and 33.7 kg/m2. In addition, there was no significant differences (p >0.05) of transfusion practice of sub stratified BMI groups, <35 or >35 within the three EBL groups.
Discussion: While our data is very preliminary, it appears that BMI does not seem to impact blood loss in patients that underwent C-section. Given the increased incidence in obesity in the obstetric population, it is important to know if blood transfusion protocols have different effectiveness for differing BMI subpopulations. When a full collection and analysis is complete, a better picture will emerge if there is any link between them.
Conclusion: Preliminary results suggest that high body mass index does not adversely affect transfusion practice.
1. Blanchette H. The rising cesarean delivery rate in America: What are the consequences? Obstet Gynecol 2011;118(3): 687-690.
2. Kramer MS, Dahhou M, Vallerand D, Liston R, Joseph KS. Risk factors for postpartum hemorrhage: Can we explain the recent temporal increase? J Obstet Gynaecol can 2011;33(8): 810-819.
3. Kramer MS, Dahhou M, Vallerand D, Liston R, Joseph KS. Risk factors for postpartum hemorrhage: Can we explain the recent temporal increase? J Obstet Gynaecol can 2011;33(8): 810-819.
4. Fyfe EM, Anderson NH, North RA, Chan EH, Taylor RS, Dekker GA, McCowan LM, Screening for Pregnancy Endpoints (SCOPE) Consortium. Risk of first-stage and second-stage cesarean delivery by maternal body mass index among nulliparous women in labor at term. Obstet Gynecol 2011;117(6): 1315-1322.