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Blood transfusion during caesarean section for placenta previa: 5year review from a large maternity hospital.
Abstract Number: T-36
Abstract Type: Original Research
Background: 4 per 1000 pregnancies are complicated by placenta previa (1) and the risk of massive haemorrhage is 12 times more likely with placenta previa(2). Blood transfusion for caesarean section is needed in 1.8–23.5%, irrespective of the indication(3, 4). Intra operative cell salvage (IOCS) reduces the need for allogenic transfusion.
Methods: We performed a retrospective audit to reflect on our practice of blood transfusion IOCS during caesarean sections in patients with placenta previa between 2004 and 2008. We collected the following data from electronic medical records: age, parity, position and grade of placenta, type of anaesthesia, previous caesarean section, intra operative blood loss, pre operative haemoglobin (Hb), post operative Hb and the amount of blood products being transfused.
Results: 157 singleton pregnancies with placenta previa underwent caesarean section in our study period. 37(24%) patients out of 157 needed blood transfusion. The estimated average blood loss in those who were transfused was 1433ml. There was no difference in the amount of blood loss between patients who had spinal anaesthesia and those who had general anaesthesia. Average pre operative Hb was 11g/dl and the average drop in Hb was 2.6g/dl.
10 (27%) patients received only IOCS and 2(5%) patients received both IOCS and allogenic transfusion. 25 (68%) patients had allogenic transfusion only. The median value of allogenic transfusion is 2 units of red blood cells. There were 6 hysterectomies and 5 of them received cell salvaged blood. Patients who had caesarean hysterectomies had fresh frozen plasma, platelets and other patients did not need them. During this period a total of 13L of IOCS blood was collected and being transfused back to the patients. Mean value of IOCS blood was 974ml.
Conclusion: Approximately 1 in 4 patients who underwent caesarean section for placenta previa needed blood transfusion. Use of cell salvage reduced the need for allogenic transfusion. No adverse effects were found in patients who had cell salvage, which should be used routinely for all patients who have the risk of major haemorrhage.
1. Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med. Mar 2003; 13(3):175-90.
2. Royal College of Obstetricians and Gynaecologists. Green–top Guideline No.52: Prevention and management of postpartum haemorrhage. London: RCOG; 2009
3. Fong J, Gurewitsch E, Kang H, Kump L, Mack P. An analysis of transfusion practice and the role of intraoperative red blood cell salvage during cesarean delivery. Anesth Analg 2007; 104:666–72.
4. Rainaldi MP, Tazzari PL, Scagliarini G, Borghi B, Conte R. Blood salvage during caesarean section. Br J Anaesth 1998; 80:195–8.