A cross-sectional study of peripartum blood transfusion in the Eastern Cape, South Africa

Berg, Karin van den; Bloch, EM; Aku, AS; Mabenge, Mfundo; Creel, Darryl; Hofmeyr, G Justus; Murphy, Edward L.

doi:10.7196/samj.2016.v106i11.10870

Cited by 6 publications

(8 citation statements)

References 14 publications

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“…The studies among pediatric patients showed that 64% (2810 of 4387) of blood products were transfused for malaria. Postpartum hemorrhage (PPH) at 24% (524 of 2228) and cesarean sections at 22% (485 of 2228) were the most transfused diagnostic categories among the obstetrics and gynecology patients, with abortions and cancer accounting for only 10% and 8% of transfusions, respectively. Within the cesarean section–only studies, placenta previa at 27% (47 of 431) and obstructed labor at 25% (44 of 431) were the leading indications for transfusion.…”

Section: Resultsmentioning

confidence: 99%

“…These 10 studies were used for the primary outcome calculation. The rest of the studies evaluated blood use among specific patient groups: nine studies among pediatric patients only; five on obstetrics and gynecology patients; three among cesarean section deliveries; three among newborn babies; two among elective surgical operations; two exclusively on the use of platelets; two on the use of autologous blood; and one among hepatogastroenterology patients . Most studies made a clear distinction between the number of patients transfused and the number of blood products used for transfusion.…”

Section: Resultsmentioning

confidence: 99%

“…In the pooled analysis of the nine studies that included only children, it was found that 64% of blood products were used for children with severe malaria. Similarly, from the five pooled studies in obstetrics and gynecology, over one‐half (54%) of blood products were used for obstetric hemorrhage (represented here by the diagnostic categories of PPH, antepartum hemorrhage, and cesarean deliveries). The current review has shown that “other cause of bleeding” is the fourth‐leading transfusion indication, using up to 16% of blood products.…”

Section: Discussionmentioning

confidence: 99%

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Blood use in sub‐Saharan Africa: a systematic review of current data

et al. 2019

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Blood use in sub‐Saharan Africa: a systematic review of current data

et al. 2019

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“…Several studies have been conducted in South Africa to characterize peripartum blood use. [5][6][7] The findings suggest excess rates of transfusion, relative to those of several high-income countries, despite comparable rates of hemorrhage. 6 Reasons that have been postulated for these increased rates of transfusion include a high prevalence of antenatal anemia, rendering some patients unable to tolerate the physiological blood loss associated with delivery.…”

mentioning

confidence: 85%

“…Blood use offers insight into obstetric practices and outcomes, and can serve to identify deficiencies in care. Several studies have been conducted in South Africa to characterize peripartum blood use . The findings suggest excess rates of transfusion, relative to those of several high‐income countries, despite comparable rates of hemorrhage .…”

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confidence: 99%

Antenatal blood transfusion in South Africa: indications and practice in a high‐HIV‐prevalence setting

et al. 2020

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BACKGROUND Globally, data on antenatal blood transfusion practices are scarce. We sought to characterize the epidemiology of antenatal transfusion in South Africa. STUDY DESIGN AND METHODS A cross‐sectional study was conducted of women who were transfused during pregnancy (>48 hr before anticipated delivery) at two hospitals in Durban and Soweto in 2014 to 2015. Medical record data on demographics, obstetric history, anemia, HIV status, and indications for blood transfusion were abstracted. RESULTS The records on a total of 560 transfused pregnant women were evaluated; mean age was 28 years, 98% were of black African ethnicity, and 28% were HIV positive. At time of transfusion, one‐half were in the first trimester. Hemorrhage was noted in 76% of women, most of which was associated with abortion (67%) or ectopic pregnancy (27%). Most women were transfused with red blood cells (RBCs; median, 2 units); 14% of women were transfused with plasma and 2% with platelets. Median pre‐ and posttransfusion hemoglobin levels were 6.9 g/dL and 9.2 g/dL, respectively; the latter differed by hospital (8.7 g/dL vs. 9.5 g/dL; p < 0.01). Hemorrhage was associated with missing HIV status, lower gestational age, and transfusion of 3 or more RBC units (all p < 0.01). In contrast, diagnoses of anemia (Soweto only) were associated with HIV infection, later gestational age, and lower (<3 units) RBC dose (all p < 0.01). CONCLUSION Abortion and ectopic pregnancy with associated hemorrhage were the leading indications for antenatal transfusion and were concentrated in early gestation. By contrast, anemia was associated with HIV infection and transfusion in the third trimester.

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Development of a machine learning approach for prediction of red blood cell transfusion in patients undergoing Cesarean section at a single institution

Lee,

Park,

Seo

et al. 2024

Sci Rep

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Despite recent advances in surgical techniques and perinatal management in obstetrics for reducing intraoperative bleeding, blood transfusion may occur during a cesarean section (CS). This study aims to identify machine learning models with an optimal diagnostic performance for intraoperative transfusion prediction in parturients undergoing a CS. Additionally, to address model performance degradation due to data imbalance, this study further investigated the variation in predictive model performance depending on the ratio of event to non-event data (1:1, 1:2, 1:3, and 1:4 model datasets and raw data).The area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC) were evaluated to compare the predictive accuracy of different machine learning algorithms, including XGBoost, K-nearest neighbor, decision tree, support vector machine, multilayer perceptron, logistic regression, random forest, and deep neural network. We compared the predictive performance of eight prediction algorithms that were applied to five types of datasets. The intraoperative transfusion in maternal CS was 7.2% (1020/14,254). XGBoost showed the highest AUROC (0.8257) and AUPRC (0.4825) among the models. The most significant predictors for transfusion in maternal CS as per machine learning models were placenta previa totalis, haemoglobin, placenta previa partialis, and platelets. In all eight prediction algorithms, the change in predictive performance based on the AUROC and AUPRC according to the resampling ratio was insignificant. The XGBoost algorithm exhibited optimal performance for predicting intraoperative transfusion. Data balancing techniques employed to alter the event data composition ratio of the training data failed to improve the performance of the prediction model.

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A cross-sectional study of peripartum blood transfusion in the Eastern Cape, South Africa

Abstract: These findings confirm high rates of peripartum transfusion in SA. While this can be possibly ascribed to variability in practice and patient profile, variation in care and improvement in HIV treatment should be considered.

Cited by 6 publications

References 14 publications

Blood use in sub‐Saharan Africa: a systematic review of current data

Blood use in sub‐Saharan Africa: a systematic review of current data

Antenatal blood transfusion in South Africa: indications and practice in a high‐HIV‐prevalence setting

Development of a machine learning approach for prediction of red blood cell transfusion in patients undergoing Cesarean section at a single institution

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