Incidence, trends and risk factors for obstetric massive blood transfusion in China from 2012 to 2019: an observational study

ObjectivesThis study aims to use the high-quality national monitoring data from the China’s National Maternal Near Miss Surveillance System (NMNMSS) to ascertain the incidence, trends and risk factors of obstetric massive blood transfusion (MBT) from 2012 to 2019 in China and determine its clinical outcomes.SettingsObservational study of hospitalised pregnancies who had given birth or ended their pregnancy among member hospitals of NMNMSS.Participants11 667 406 women were included in this study.Primary and secondary outcome measuresWe screened for the incidence, trends, risk factors and main reasons for obstetric MBT, and the outcomes after obstetric MBT. MBT was defined as the transfusion of ≥5 units of red blood cells or ≥1000 mL of whole blood. The incidence of MBT was defined as the MBT cases per 10 000 pregnancies.ResultsObstetric MBT occurred in 27 626 cases, corresponding to an incidence of 23.68 per 10 000 maternities, which exhibited an increasing trend in China during 2012–2019 (14.03–29.59 per 10 000 maternities, p for trend <0.001). Obstetric MBT was mainly associated with amniotic fluid embolism, uterine atony, abnormal placenta, severe anaemia, ectopic pregnancy, abortion, caesarean section, advanced maternal age and multiparous from biological effect. While from sociological effects, uterine atony, severe anaemia and placenta previa are the top three complications which more likely to undergo obstetric MBT in the Chinese population. Overall, the secular trends of hysterectomy incidence (25.07%–9.92%) and MMR during hospitalisation (21.41‰–7.48‰) among women who underwent MBT showed decreasing trends (p for trend <0.001).ConclusionTo minimise the incidence of obstetric MBT, more attention should be paid to education on the importance of the antenatal visit, evidence-based transfusion practice and females who are multiparous and have an advanced age, amniotic fluid embolism, uterine atony, severe anaemia and placenta previa.

Download Full-text

Massive blood transfusion in relation to delivery: incidence, trends and risk factors: a population‐based cohort study

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/1471-0528.15927 ◽

2019 ◽

Vol 126 (13) ◽

pp. 1577-1586 ◽

Cited By ~ 6

Author(s):

L Thurn ◽

A Wikman ◽

M Westgren ◽

PG Lindqvist

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Blood Transfusion ◽

Population Based ◽

Massive Blood Transfusion ◽

Incidence Trends

Download Full-text

Massive Blood Transfusion in Relation to Delivery: Incidence, Trends, and Risk Factors: A Population-based Cohort Study

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000693684.70869.3a ◽

2020 ◽

Vol 40 (3) ◽

pp. 125-126

Author(s):

L. Thurn ◽

A. Wikman ◽

M. Westgren ◽

P.G. Lindqvist

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Blood Transfusion ◽

Population Based ◽

Massive Blood Transfusion ◽

Incidence Trends

Download Full-text

842: Role of inflammation in uterine isthmus leading to uterine atony: pathophysiology of Amniotic Fluid Embolism.

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2018.11.865 ◽

2019 ◽

Vol 220 (1) ◽

pp. S549-S550

Author(s):

Divyanu Jain ◽

Tomoaki Oda ◽

Naoaki Tamura ◽

Hiroaki Itoh ◽

Naohiro Kanayama

Keyword(s):

Amniotic Fluid ◽

Uterine Atony ◽

Amniotic Fluid Embolism

Download Full-text

Emergency Peripartum Hysterectomy as Postpartum Hemorrhage Treatment: Incidence, Risk factors, and Complications

Journal of Nepal Medical Association ◽

10.31729/jnma.2375 ◽

2014 ◽

Vol 52 (193) ◽

pp. 668-676 ◽

Cited By ~ 3

Author(s):

Meena Pradhan ◽

Yong Shao

Keyword(s):

Risk Factors ◽

Caesarean Section ◽

Blood Loss ◽

Postpartum Hemorrhage ◽

Placenta Previa ◽

Uterine Atony ◽

Previous Caesarean Section ◽

Peripartum Hysterectomy ◽

Incidence Risk ◽

Emergency Peripartum Hysterectomy

Introduction: The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage.Methods: This is a single center case-control study conducted in Chongqing city in central China from 1st January 2007 to 31st December 2012 for emergency peripartum hysterectomy performed as a treatment of postpartum hemorrhage both in caesarean and vaginal delivery cases. While the study group included emergency peripartum hysterectomy (n=61) due to intractable postpartum hemorrhage, the control group included no hysterectomy (n=333) during the same study period.Results: We found 61 cases recorded for emergency peripartum hysterectomy for intractable postpartum hemorrhage. Incidence of peripartum hysterectomy was 2.2 per 1000 deliveries. Emergency peripartum hysterectomy as treatment of intractable postpartum hemorrhage include the followings: (i) blood loss 1000-2000 ml, crude odd ratio (OR) =18.48 (95% CI 5.1-65.7), adjusted odd ratio (AOR) = 9.1 (95% CI 2.2-37.7); (ii) blood loss >2000 ml, OR = 152 (95% CI 43.7-528.4), AOR = 45.3 (95% CI 11.6-176.9); (iii) previous caesarean section, OR = 5.5 (95% CI 2.9-9.7), AOR = 3.7(95% CI 1.4-9.9); (iv) uterine atony, OR = 11.9 (95% CI 5.8-24.6), AOR = 7.5 (95% CI 1.8-30.2); (v) placenta previa, OR = 2.04 (95% CI 1.1-3.5), AOR = none. Conclusions: Emergency peripartum hysterectomy is the last resort as treatment of intractable severe postpartum hemorrhage. Our study depicts that severe post partum hemorrhage, further dreaded complex events for emergency peripartum hysterectomy, has significant association with placental factors, previous caesarean section, and uterine atony. Pathologically, placenta accreta remained the most leading cause of hysterectomy.Keywords: caesarean section; hemorrhage; peripartum hysterectomy; placenta previa.

Download Full-text

Prospective observational study of risk factors and maternofetal outcome of placenta previa at LMICs

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20203911 ◽

2020 ◽

Vol 7 (9) ◽

pp. 3488

Author(s):

Manju Lata Verma ◽

Uma Singh ◽

Vandana Solanki ◽

Amrita Singh ◽

Rekha Sachan ◽

...

Keyword(s):

Risk Factors ◽

Observational Study ◽

Prospective Observational Study ◽

Placenta Previa ◽

Fetal Outcome ◽

Team Work ◽

Chi Square ◽

Exact Test ◽

Qualitative Variables ◽

Operative Findings

Background: This study was conducted to assess incidence, risk factors, maternal and fetal outcome in patients of placenta previa (PP).Methods: Department of Obstetrics and Gynecology, King George Medical University, Lucknow. Hospital based prospective observational study. Patients attending to the antenatal outdoor patient unit with diagnosis of PP and patients coming to emergency with the complaints of antepartum hemorrhage (APH) because of placenta previa. Detailed history, clinical examination, imaging by transabdominal ultrasound, antenatal complications, per-operative findings, maternal and fetal outcome were assessed. Qualitative variables were compared using Chi square test/ Fisher’s exact test as appropriate. Statistical analysis was done using SPSS version 21.Results: Incidence of PP was 2.8% (271/9404). Mean age was 28.23±4.58 years. 37.3%, delivered between 28-33.6 weeks. 229 (84.5%) had emergency LSCS. 205 (75.6%) cases of placenta previa had active bleeding. 53 (19.6%) cases had PPH and 2 maternal mortalities occurred due to hemorrhagic shock.Conclusions: Placenta previa is associated with definitely poor maternal and fetal outcome which can be better managed with multidisciplinary team work.

Download Full-text

The bleeding mother and her baby: a study to determine the fetomaternal outcome in cases of placenta previa

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203855 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3775

Author(s):

Preeti Frank Lewis ◽

Sana Tarannum Bijapur ◽

Deepika Gurnani

Keyword(s):

Risk Factors ◽

Blood Transfusion ◽

Uterine Artery ◽

Placenta Previa ◽

Tertiary Care ◽

Previous History ◽

Fetal Outcome ◽

Care Hospital ◽

Artery Ligation ◽

Uterine Artery Ligation

Background: Placenta previa is one of the major causes for obstetric hemorrhagic morbidity and mortality with increasing incidence in recent times. This study aims at determining risk factors, maternal and fetal outcome associated with placenta previa.Methods: This was an observational, retrospective study conducted at a tertiary care hospital in Mumbai from May 2017 to March 2020. A total of 102 women with placenta previa during the study period were included, their case records critically analyzed to identify risk factors, maternal outcome in relation with blood transfusion required, ICU admission, obstetric hysterectomy and fetal outcome pertaining to prematurity, asphyxia and mortality.Results: A total of 102 patients were analyzed. Placenta previa was more common in >26 years of age, multipara (64.7%), with previous history of caesarean sections (21.5%) and previous curettage (11.7%), 44.2% babies born were preterm, 4.4% stillbirths and 8.5% neonatal deaths. Maternal complications like antepartum hemorrhage was seen in 58.8% patients and postpartum hemorrhage in 33.3%, blood transfusion was required in only 18 patients post operatively, bladder rent was seen in 3 patients and there was no maternal mortality. 44 patients required uterine artery ligation, Ashok Anand stitch was taken in 37 patients, uterus compression sutures in 10, obstetric hysterectomy in 7 patients and internal iliac artery ligation in 2 patients.Conclusions: Early identification of women at risk, obstetric preparedness and simple techniques like uterine artery ligation, Ashok Anand stitch and uterine compression sutures can help in effectively reducing need for multiple blood transfusions and morbidity.

Download Full-text