Antepartum and Intrapartum Characteristics Associated With Postpartum Blood Transfusion [03M]. (May 2020)

• Record Type: Journal Article
• Authors: Farr, Carly; Ogunyemi, Dotun; Bauer, Samuel; Karabon, Patrick; Bahado-Singh, Ray; Alhousseini, Ali
• Is Part Of: Obstetrics and gynecology. Volume 135(2020)Supplement 1
• Publication Date: 2020-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000664720.20203.1e
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: Risk assessment is the first step in an Obstetrics Hemorrhage Safety Bundle. Accurate elucidation of prenatal and intrapartum risk factors can facilitate the reduction of severe maternal morbidity and mortality due to postpartum hemorrhage. METHODS: Retrospective cohort study of 27, 886 women evaluated for antepartum and intrapartum factors associated with postpartum blood transfusion. Univariate and multivariate logistic regression and propensity score analyses were performed, and odds ratio were derived. P-values<0.05 were considered statistically significant. RESULTS: 245 of 27, 886 mothers required blood transfusion. On multivariate logistic regression adjusting for all factors, statistically significant independent associations of blood transfusion were general anesthesia (OR 6.01; P= .0002), severe preeclampsia (OR 3.34; P<.0001), chorioamnionitis (OR 3.09; P<.0001) and the use of multiple methods for cervical ripening (OR 2.03; P= .0098). Milder independent associations were previous cesarean delivery (OR 1.83; P= .0037), gestational hypertension (OR 1.55; P= .0283), and gestational diabetes (OR 1.55; P= .0410). Using propensity score inverse probability of treatment weighting multivariable model, independent associations of blood transfusion were cervical dilation on admission <2 cm, effacement <60%, and station <-3, duration of all stages of labor (all P< .0001) and intrapartum therapy with intravenous anti-hypertensives (ORPS 2.53; P<.0001), Magnesium (ORPS 2.94; P<.0001), opioids (ORPS 2.17; P<.0001), Clindamycin/Gentamicin (ORPS 3.91; P<.0001), and uterotonics (ORPS 14.3; P<.0001). CONCLUSION: Treatment of intrapartum complications contribute more to the need for blood transfusion than prenatal risk factors. Avoiding general anesthesia, reducing labor induction and prolonged labor are potential preventable causes of postpartum hemorrhage requiring blood transfusion.