Blood transfusion following intended vaginal birth after cesarean vs elective repeat cesarean section in women with a prior primary cesarean: A population‐based record linkage study

Abstract

Introduction:There is a lack of evidence around the risk of transfusion following vaginal birth after cesarean (VBAC) compared with elective repeat cesarean section (ERCS); this is important for decision-making about birth options. The aim of this study was to determine transfusion rates and risk of transfusion following intended VBAC and ERCS. Material and methods: Women with a primary cesarean who had a subsequent birth at term (≥37 weeks) in New South Wales between 2000 and 2012, were identified from the New South Wales Perinatal Data Collection. Blood transfusions were identified from linked hospital records. Women deemed ineligible for VBAC were excluded. Modified Poisson regression was used to determine transfusion risk associated with intended VBAC compared with ERCS. Intended mode of birth was classified as: (1) intended VBAC and vaginal birth, (2) intended VBAC and cesarean, (3) intended ERCS and (4) "intention uncertain".Results: A total of 90 439 women were eligible for VBAC. Rates of transfusion were:1.4% for intended VBAC and vaginal birth (n = 17 849); 1.2% for intended VBAC and cesarean (n = 7648); 0.3% for intended ERCS (n = 60 471); and 1.1% for "intention uncertain" (n = 4471). After adjusting for maternal and pregnancy characteristics, risk of transfusion was almost four times higher for women classified as intended VBAC than intended ERCS (adjusted risk ratio = 3.73, 95% confidence interval 2.90-4.78). Conclusions:Following a prior primary cesarean, there was a higher risk of transfusion associated with attempting VBAC compared with ERCS. Though the absolute risk is small, it is important for women considering VBAC to choose birthing facilities with ready access to blood products. K E Y W O R D S blood transfusion, intended mode of birth, postpartum hemorrhage, primary cesarean, vaginal birth after cesarean | 383 PONT eT al.

Prediction and Evaluation of Machine Learning Algorithm for Prediction of Blood Transfusion during Cesarean Section and Analysis of Risk Factors of Hypothermia during Anesthesia Recovery

“…In a retrospective study of patients undergoing blood transfusion after cesarean section, Abbas et al pointed out that the main causes of blood transfusion are uterine weakness, scarred uterus, placental adhesion, placenta accreta, prenatal anemia, placenta previa, and so on [ 17 ]. Pont et al found that the increase of blood transfusion rate during cesarean section after the opening of the comprehensive “two-child policy,” ASA grade III-IV, operation time longer than 60 min, and preoperative complications were independent risk factors for blood transfusion during cesarean section [ 18 ]. He et al proposed that placenta previa is the primary risk factor for intraoperative blood transfusion for second cesarean section, and women with placenta previa have a higher probability of intraoperative blood transfusion [ 19 ].…”

Vaginal birth after Cesarean experience in Romania: A retrospective case‑series study and online survey

“…In a study by Pont et al ( 16 ), the authors concluded that the risk of transfusion was higher for women attempting vaginal birth after a primary CS than after a planned repeat Cesarean. In our study, the necessary of blood transfusion was small, and was required in two cases of VBAC with vacuum extraction that had cervical tears.…”

Postpartum hemorrhage and blood transfusion among parturients with scarred uterus – The evidence is there

“…1 They performed a retrospective population-based record linkage study evaluating the transfusion risk associated with intended vaginal birth after cesarean (VBAC) compared to elective repeat cesarean section (ERCS). 1 They performed a retrospective population-based record linkage study evaluating the transfusion risk associated with intended vaginal birth after cesarean (VBAC) compared to elective repeat cesarean section (ERCS).…”

“…We read the study by Pont et al with great interest. 1 They performed a retrospective population-based record linkage study evaluating the transfusion risk associated with intended vaginal birth after cesarean (VBAC) compared to elective repeat cesarean section (ERCS).…”