Obstetric Emergencies and Transfusion Needs in a Nigerian Hospital

Abstract

IBlood transfusion plays a significant role as a life-saving practice in emergency obstetrics and it is one of the essential components of comprehensive emergency obstetric care yielding a reduction in maternal mortality. While transfusion is commonly used to combat anaemia in obstetric practice, the majority of patients receiving transfusion are given to otherwise healthy women in response to undiagnosed obstetric hemorrhage. This study explores the need and blood transfusion rate among obstetrics patients at the University College Hospital (UCH), Ibadan to provide insight into the rationale behind such practices. This is a retrospective study of transfused obstetrics patients at UCH between the year 2009 and 2014. Information was extracted from their medical records using a pro-forma. Data were entered and analysed using SPSS version 20.Of the 21,208 births and 27,019 antenatal admissions during the study period, 597 patients were transfused and 565 medical records were analysed. Among these 565 patients, about two-thirds 412 (72.9%) were un-booked patients. The transfusion rate was 2.2% and the commonest associated obstetrics complication requiring transfusion was anaemia (65.5%) while 184 (32.6%) were transfused because of postpartum hemorrhage. Other indications for transfusion were abruptio placentae, malaria and placenta previa. Patients who delivered via Caesarean Section (CS) had the highest transfusion rate of 62.4% and the estimated blood loss during delivery was significantly higher among the unbooked patients (P<0.01). More than two-thirds, 466 (82.5%) received whole blood while only 2 (0.4%) received cryoprecipitate. About one-third of patients received single unit-transfusions.Though the overall obstetric transfusion rate was lower than that of comparable facilities, the transfusion rate among patients receiving CS was markedly high. Additionally, the majority of transfused obstetric patients had complications resulting in anaemia, while hemorrhage propagated the second highest number of cases requiring transfusion.

Pattern of utilization of blood and blood components in obstetrics at a tertiary care center: a cross-sectional study

“…PPH is usually troublesome as it can cause massive haemorrhage. Similar to present study, PPH was the second common cause of BT (32.6%) in the study by Akingbola et al 14 In study by Bangal et al accidental haemorrhage was the second most common cause (20.92%). 13 Even in a similar study by Renuka et al postpartum haemorrhage was the second common cause for blood transfusion present in 21.54% patients.…”

“…13 Akingbola et al reported that the overall transfusion rate was 2.2%; 78.7% were transfused at delivery and 22.3% were transfused during pregnancy. 14 The rate of requirement of blood in the studies may vary due to the complexity of cases observed at the facility, due to its status as a tertiary institution as well as referral centre and booking status. This difference in findings of studies could also be explained by different transfusion practices among institutions, low availability of donor blood in our environment, or case mix.…”

“…18 Among other studies, Akingbola et al reported other causes of BT as severe malaria in 0.7% patients, placenta previa in 0.7%, and abruptio placenta in 0.5% patients. 14 In study by Bangal et al other causes of BT were placenta praevia (5.3%) and ruptured ectopic pregnancy (5.03%). 13 Less common indications were abortions, complications of third stage of labour, vesicular mole evacuation etc.…”

“…21 Our findings were in line with the study by Akingbola et al who mentioned that the most common indication for blood transfusion was anaemia (65.5 %). 14 Even Bangal et al reported that severe anaemia either during pregnancy or during postpartum period was most common indication (36.55%) for blood transfusion. 13 The findings are also supported by Renuka et al where severe anaemia either during pregnancy or during postpartum period was the most common indication (39.96%) for transfusion.…”

Risk factors for blood transfusion in traumatic and postpartum hemorrhage patients: Analysis of the CRASH-2 and WOMAN trials

“…Most patients in the lower-middle-income country category were from Nigeria and Pakistan. One study found that many obstetric patients at one of the trial sites-University College Hospital, Ibadan-received single unit blood transfusions despite the need for additional units, based on estimated blood loss or low hematocrit values [48,49]. Similarly, in Pakistan, a 40% shortage of blood and blood components limits the amount of donated blood available for transfusion [50].…”