Massive Blood Transfusion: A Population-Based Sample from New York State
Abstract Number: T-25
Abstract Type: Original Research
Introduction: The overall rate of PPH increased 27.5% from 1995 to 2004 in the United States,(1); it is unknown whether this trend also applies to the most severe cases, women receiving massive blood transfusion (MBT). Inpatient administrative data from New York State includes a variable for the number of units of blood products transfused. We analyzed a sample of admissions for delivery in New York hospitals to ascertain recent trends, risk factors, and outcomes for MBT for obstetric hemorrhage.
Methods: Hospitalizations for delivery were extracted for 1998-2007 using an enhanced algorithm of ICD-9-CM diagnostic and procedural codes, and analysis was restricted to deliveries in hospitals that reported ≥1 unit transfused to ≥1 patient during each year of the study. We defined MBT as ≥10 Units recorded in the setting of obstetric hemorrhage. The underlying etiology was defined in a hierarchical manner. Risk factors for MBT were determined by examining a range of obstetric conditions. The association of MBT with various maternal outcomes was ascertained. Finally, for the subset of hospitals present in the dataset for all ten years, we examined a trend in the occurrence of MBT.
Results: 406 women received MBT for obstetric hemorrhage from a cohort of 690,742 delivery hospitalizations, for a rate of 5.9 per 10,000 deliveries. The most common etiologies were abnormal placentation, uterine atony, placental abruption, and coagulopathy (see Figure). Apart from proximate etiologies of hemorrhage, other risk factors for MBT include intrauterine fetal demise (odds ratio (OR) 20.1, 95% confidence interval (CI) 14.7 - 27.4) severe preeclampsia (OR 16.1, 95% CI12.0 - 21.5), fibroids (OR 4.8, 95% CI 3.2 - 7.3), chorioamnionitis (OR 3.2, 95% CI 2.1 – 5.0), multiple gestation (OR 2.9, 95% CI 2.0 - 4.4), and trial of labor after Cesarean delivery (OR 1.6, 95% CI 1.3 - 2.1). Maternal complications associated with MBT included acute renal failure (17.5%), acute respiratory distress syndrome (19.5%), hysterectomy (49.3%), and in-hospital death (4.7%). The rate of MBT increased 14% between the first and second half of the study period, but this trend was non-significant (p=0.4).
Conclusion: Women who receive ≥10 Units of blood face substantial risk for major end organ injury, loss of fertility, and in-hospital maternal death. This analysis was insufficiently powered to identify any significant trend in MBT.
1) Anes Analg 2010; 110:1368-73