Accuracy of blood transfusion in postpartum hemorrhage to assess maternal morbidity

Shrivastava, Paul; Mourtialon, P.; Benzenine, Éric; Bardou, Marc; Ferdynus, Cyril; Morel, Pascal; Quantin, Catherine

doi:10.1016/j.ejogrb.2012.02.021

Cited by 17 publications

(11 citation statements)

References 22 publications

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“…The transfusion rate documented in our study is comparable to that reported from the USA (7/1000 in a study from 1998 to 2011 using Nationwide Inpatient Sample data) 16 and the Burgundy region of France (6.5/1000) 13 but lower than that reported from New South Wales, Australia (14/ 1000), 7 and Finland (19.8/1000) during the delivery admission among singleton deliveries. 17 The report from New South Wales further reported a crude rate of inter-institutional variation of 6-29 per 1000, reasonably similar to the range of our crude rates (3.7-23.6 per 1000).…”

Section: Discussionsupporting

confidence: 76%

“…Important strengths of our study included its use of linked transfusion records from our provincial Central Transfusion Registry rather than reliance on chart abstraction, which has been shown to underestimate transfusion use. [13][14][15] Our use of a population-based database with provincially standardised data collection and quality assurance helped to ensure comparability in risk factors and other characteristics between sites. Nevertheless, our study was lacking information on the indication for transfusion, which would have been valuable in exploring patterns of between-site variation.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Inter‐hospital variation in use of obstetrical blood transfusion: a population‐based cohort study

Hutcheon

Chapinal

Skoll

et al. 2020

BJOG

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Objective To identify the extent of hospital‐to‐hospital variation in use of obstetrical blood transfusion. Design Population‐based cohort study linking provincial perinatal and blood transfusion registries. Setting British Columbia, Canada, 2004–2015. Population All pregnant women delivering at or beyond 20 weeks’ gestation at any British Columbia hospital. Methods Mixed‐effects regression models were used to estimate hospital‐specific transfusion rates after sequentially accounting for (1) the role of random variation, (2) maternal medical and obstetrical characteristics (i.e. patient case mix) and (3) institutional and delivery factors (such as use of instrumental or caesarean delivery). Main outcome measures Hospital‐specific use of obstetrical red blood cell transfusion. Results Among 44 hospitals, crude institutional transfusion rates across the study period ranged from 3.7 to 23.6 per 1000, with an average of 8.3 per 1000. After adjusting for maternal characteristics, institution and delivery risk factors, a nearly three‐fold difference in rates between the 10th and 90th percentile remained (5.4–14.5 per 1000). Twelve sites had rates significantly higher or lower than the provincial average. Women residing in remote areas were 2.5‐fold (95% CI 1.8–3.5] more likely to receive a blood transfusion than were women residing in metropolitan areas. Conclusions Meaningful variation between hospitals in use of blood transfusion during pregnancy was not explained by differences in patient case‐mix or institutional factors, suggesting that over‐ or under‐utilisation of this resource may be occurring in obstetrical care. Tweetable abstract Use of blood transfusion in pregnant women varied broadly between hospitals in British Columbia, Canada.

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Section: Discussionsupporting

confidence: 76%

Section: Strengths and Limitationsmentioning

confidence: 99%

Inter‐hospital variation in use of obstetrical blood transfusion: a population‐based cohort study

Hutcheon

Chapinal

Skoll

et al. 2020

BJOG

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“…The incidence of bleeds .2500 mL (6/1000) was similar to a recent confidential audit (5.9/1000) 4 and the proportion transfused comparable to national reports. 6,8,[23][24][25][26] Women were managed on routine protocols and had received variable amounts of crystalloid and colloid before inclusion; therefore, the results are applicable to many maternity units and different clinical situations. Limitations are that blood loss at study enrolment is difficult to quantify and that, although the Fibtem result was not known by the clinicians, they could react to the fibrinogen result when it became available.…”

Section: Discussionmentioning

confidence: 99%

Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study

Collins

Lilley

Bruynseels

et al. 2014

Blood

207

228

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“…Defining the incidence of PPH, and comparing results of studies, is hampered by the lack of a standardised approach to blood loss assessment [2]. Visual estimation, although widely used, is inaccurate and often associated with under-reporting of actual blood loss, especially in cases of large volumes of PPH [3][4][5][10][11][12][13][14][15][16][17][18][19]. Systematic reviews confirm that the incidence of PPH is higher with quantitative measurement, as opposed to visual estimation and this leads to inaccurate reporting of the incidence and severity of PPH [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort

Bell

Watkins

John

et al. 2020

BMC Pregnancy Childbirth

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Background: Visual estimation of blood loss following delivery often under-reports actual bleed volume. To improve accuracy, quantitative blood loss measurement was introduced for all births in the 12 hospitals providing maternity care in Wales. This intervention was incorporated into a quality improvement programme (Obstetric Bleeding Strategy for Wales, OBS Cymru). We report the incidence of postpartum haemorrhage in Wales over a 1year period using quantitative measurement. Methods: This prospective, consecutive cohort included all 31,341 women giving birth in Wales in 2017. Standardised training was cascaded to maternity staff in all 12 hospitals in Wales. The training comprised mockscenarios, a video and team drills. Uptake of quantitative blood loss measurement was audited at each centre. Data on postpartum haemorrhage of > 1000 mL were collected and analysed according to mode of delivery. Data on blood loss for all maternities was from the NHS Wales Informatics Service. Results: Biannual audit data demonstrated an increase in quantitative measurement from 52.1 to 87.8% (P < 0.001). The incidence (95% confidence intervals, CI) of postpartum haemorrhage of > 1000 mL, > 1500 mL and > 2000 mL was 8.6% (8.3 to 8.9), 3.3% (3.1 to 3.5) and 1.3% (1.2 to 1.4), respectively compared to 5%, 2% and 0.8% in the year before OBS Cymru. The incidence (95% CI) of bleeds of > 1000 mL was similar across the 12 hospitals despite widely varied size, staffing levels and case mix, median (25th to 75th centile) 8.6% (7.8-9.6). The incidence of PPH varied with mode of delivery and was mean (95% CI) 4.9% (4.6-5.2) for unassisted vaginal deliveries, 18.4 (17.1-19.8) for instrumental vaginal deliveries, 8.5 (7.7-9.4) for elective caesarean section and 19.8 (18.6-21.0) for non-elective caesarean sections. Conclusions: Quantitative measurement of blood loss is feasible in all hospitals providing maternity care and is associated with detection of higher rates of postpartum haemorrhage. These results have implications for the definition of abnormal blood loss after childbirth and for management and research of postpartum haemorrhage.

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Accuracy of blood transfusion in postpartum hemorrhage to assess maternal morbidity

Cited by 17 publications

References 22 publications

Inter‐hospital variation in use of obstetrical blood transfusion: a population‐based cohort study

Inter‐hospital variation in use of obstetrical blood transfusion: a population‐based cohort study

Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study

Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort

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