Obstetric Features of Large-Volume Red Blood Cell Transfusions in Parturients with Postpartum Hemorrhage: a Cross-Sectional Study.

BACKGROUND

Packed red blood cell (pRBC) transfusion is a common therapeutic intervention for the treatment of postpartum hemorrhage (PPH). This study aimed to describe obstetric characteristics related to large-volume pRBC transfusions in pregnant women with PPH and evaluate the effect of blood conservation strategies and maternal outcomes.

METHODS

This retrospective study included all parturients who received pRBC transfusions from 2016 - 2022 at a class A tertiary general hospital. Large-volume pRBC transfusions were defined as the receipt of ≥ 4 pRBC units during the postpartum period (within 24 hours). Numerous prenatal factors related to previous pregnancy/labor/ abortion, pregnancy complications, or antenatal laboratory indicators, as well as blood conservation strategies and maternal outcomes, were identified and compared.

RESULTS

Out of the 305 (305/24,997; 1.2%) women who received pRBC transfusions, 156 (51.1%) received ≥ 4 pRBC units during the postpartum period (within 24 hours). Women with large-volume pRBC transfusions had a greater prevalence of previous cesarean delivery (40.4%) and abortion (63.5%) than those who received 1 - 3 pRBC units (22.8% and 52.3%, respectively), as well as parturients with a history of placenta previa/accreta, placental adhesion, and cesarean delivery. In addition, those who received ≥ 4 pRBC units had greater incidences of thrombocytopenia and hypofibrinogenemia than those who received 1 - 3 pRBC units. In addition, parturients who received more pRBCs tended to receive more positive blood protection measures, including uterine balloon tamponade, embolization, and tranexamic acid administration, as well as having a longer length of hospitalization and more prolonged ICU stays.

CONCLUSIONS

In this study, more than half of the parturients received ≥ 4 pRBC units during the postpartum period. Further studies that focus on identifying high‑risk pregnant women in prenatal settings could enable enrollment in a blood conservation program, therefore minimizing allogeneic blood transfusion (ABT)-related risks.