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

Abstract

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.