Blood transfusion and cesarean delivery.

Abstract

OBJECTIVE:

To evaluate risks for intraoperative or postoperative packed red blood cell transfusion in women who underwent cesarean delivery.

METHODS:

This was a 19-university prospective observational study. All primary cesarean deliveries from January 1, 1999, to December 31, 2000, and all repeat cesareans from January 1, 1999, to December 31, 2002, were included. Trained, certified research nurses performed systematic data abstraction. Primary and repeat cesarean deliveries were analyzed separately. Univariable analyses were used to inform multivariable analyses.

RESULTS:

A total of 23,486 women underwent primary cesarean delivery, of whom 762 (3.2%) were transfused (median 2 units, 25th% to 75th% 2-3 units). A total of 33,683 women underwent repeat [corrected] cesarean delivery, and 735 (2.2%) were transfused (median 2 units, 25th% to 75th% 2-4 units). Among primary cesareans, general anesthesia (odds ratio [OR] 4.2, 95% confidence interval [CI] 3.5-5.0), placenta previa (OR 4.8, CI 3.5-6.5) and severe (hematocrit less than 25%) preoperative anemia (OR 17.0, CI 12.4-23.3) increased the odds of transfusion. Among repeat cesareans, the risk was increased by general anesthesia (OR 7.2, CI 5.9-8.7), a history of five or more prior cesareans (OR 7.6, CI 4.0-14.3), placenta previa (OR 15.9, CI 12.0-21.0), and severe preoperative anemia (OR 19.9, CI 14.5-27.2).

CONCLUSION:

Overall, the risk of transfusion in association with cesarean is low. However, both severe preoperative maternal anemia and placenta previa are associated with markedly increased risks. The former argues for optimizing maternal antenatal iron status to avoid severe anemia and the latter for careful perioperative planning when previa complicates cesarean.

LEVEL OF EVIDENCE:

II-2.

• Authors: Dwight J Rouse, Cora MacPherson, Mark Landon, Michael W Varner, Kenneth J Leveno, Atef H Moawad, Catherine Y Spong, Steve N Caritis, Paul J Meis, Ronald J Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Alan M Peaceman, Mary Jo O'Sullivan, Baha M Sibai, Oded Langer, John M Thorp, Susan M Ramin, Brian M Mercer, National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 108 Issue 4 Pg. 891-7 (Oct 2006) ISSN: 0029-7844 [Print] United States
• PMID: 17012451 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)

Topics

• Anemia (complications, therapy)
• Blood Loss, Surgical
• Blood Transfusion (statistics & numerical data)
• Cesarean Section (adverse effects)
• Cesarean Section, Repeat (adverse effects)
• Female
• Humans
• Logistic Models
• Multivariate Analysis
• Placenta Previa (physiopathology)
• Postpartum Hemorrhage (therapy)
• Pregnancy
• Pregnancy Complications, Hematologic
• Prospective Studies
• Risk Assessment