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Antenatal Anemia and the Incidence of Maternal Small Volume Blood Transfusions
Abstract Number: F-43
Abstract Type: Original Research
Introduction: During a routine vaginal delivery blood loss is estimated to be 500mL or less, while a caesarean section is around 800-1000mL.* Prior to delivery a woman develops a physiologic anemia secondary to dilution and are classified as anemic when the hemoglobin is less than 11.0g/dL. A woman’s antenatal hemoglobin level and the likelihood of receiving a transfusion during delivery or immediately in the postpartum period has not yet been studied. The objective of this study is to determine if antenatal anemia is associated with an increased risk of receiving a blood transfusion during delivery or immediately postpartum.
Methods: This study was conducted at a regional specialist maternity hospital from 1 December 2015 to 31 September 2016 and included 8100 deliveries. Deliveries excluded from the analysis were those that were missing a pre-delivery hemoglobin or women who received greater than 2 units of red blood cells (RBCs). The cohort was divided into non-anemic and anemic women defined as a hemoglobin less than 11.0g/dL. The first objective of the study looked at the frequency of requiring a small volume RBC transfusion(≤2 units pRBCs) in antenatal anemic versus non-anemic mothers. The second objective further divided the cohort based on the route of delivery to determine if the route of delivery impacted the frequency of requiring a small volume RBC transfusion. The statistical significance between antenatal anemia and receipt of postpartum RBC transfusions was determined using a Fischer’s two-tailed exact test
Results: A total of 8100 women gave birth,of those 8039 had a pre-delivery hemoglobin and were analyzed. Of the women with antenatal anemia they were more likely to receive a small volume blood transfusion (OR 5.65, P = 0.0001, CI 3.54 – 9.02). Further division of the cohort found that women who underwent a caesarean section with anemia had an increased risk of receiving a small volume blood transfusion compared to non-anemic mothers (OR 5.58, P = 0.0001, CI 2.942 – 10.594). In women who had a vaginal delivery and antenatal anemia they had an increased risk of requiring a small volume blood transfusion compared to non-anemic women (OR 5.22, P = 0.0001, CI 3.542 – 9.02).
Conclusions: In expectant mothers with antenatal anemia they are at increased risk of requiring a small volume blood transfusion regardless of the route of delivery.
*Graves, C. R. (2017). Postpartum Hemorrhage. In Textbook of Critical Care (7th ed., pp. 1006-1011). Elsevier.