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Postpartum Hemorrhage and Blood Product Utilization: Comparison by Mode of Delivery for Childbirth
Abstract Number: S 30
Abstract Type: Original Research
Introduction: Current literature is divided on differences in the incidence of transfusion and postpartum hemorrhage (PPH) between different modes of delivery (1-3). We conducted a retrospective review at a large academic teaching hospital to compare the impact of route of delivery on blood utilization. Our study is novel in that we examined the differences in utilization for all three blood components; red blood cells (RBCs), fresh frozen plasma (FFP) and platelets (PLTs), as well as the incidence of severe PPH.
Methods: Blood utilization data were obtained for 7,330 labor and delivery patients over a 44-month period using a web-based blood management intelligence portal (Impact Online®, Haemonetics, Inc., Braintree, MA). Data were combined with our institutional database to include mode of delivery: Vaginal (n=5,038), Primary caesarean section (C/S) (n=1,428), or Repeat C/S (n=864). Modes of delivery were compared with respect to the percentage of patients given RBCs, FFP, and PLTs. Blood utilization (average number of units/patient) for all three components, and the incidence of severe PPH, (> 5 units RBC requirement) were also compared. ANOVA and Chi-squared tests were used to determine significance, defined as P < 0.05.
Results: The incidence of transfusion for all components was no different between repeat C/S and primary C/S, but was greater for both C/S groups than for vaginal delivery (Fig 1). All differences between means for units/patient were significant, except for FFP compared between repeat and primary C/S, and between primary C/S and vaginal (Fig 2). Severe PPH was more common with repeat C/S (1.8%), than with primary C/S (0.85%), or with vaginal delivery (0.22%) (P< 0.0001).
Conclusion: Differences in transfusion requirements between modes of delivery become more evident when the outcome measured is true blood utilization than when assessing only percentage of patients transfused. Not only were C/S associated with increased RBC, but also increased FFP and PLT requirements. Furthermore, repeat C/S was associated with greater utilization for RBCs and PLTs. By more clearly defining transfusion requirements and risk for PPH, these findings have implications for improving care and patient safety in the peripartum period.
1. Holm C, et al: BJOG 2012, 119:596-604.
2. Alfirevic Z, et al: Cochrane Database Syst Rev 2012, 6:1-58.
3. Larrson C, et al: J Obstet Gynaecol Can 2011, 33:796-802.