Objective: Postpartum hemorrhage is a major cause of maternal morbidity and mortality, so early identification of patients at risk is crucial. In this study, we aim to assess the risk factors for major transfusion in parturients.
Methods: A case-control study was conducted between 2011 and 2019. The cases included women who were treated with postpartum major transfusion compared with two control groups, one of which was treated with 1-2 packed red blood cells and one of which was not treated with packed red blood cells. Cases were matched with controls based on two variables: multiple pregnancies and previous history of three or more cesarean sections. A multivariable conditional logistic regression model was used to determine the role of the independent risk factors.
Results: Of the 187 424 deliveries included in the present study, 246 (0.3%) women were treated with major transfusions. After applying a multivariate analysis, maternal age (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.996-1.16), antenatal anemia with hemoglobin less than 10 g/dL (OR 12.58, 95% CI 2.86-55.25), retained placenta (OR 5.5, 95% CI 2.15-13.78), and cesarean delivery (OR 10.12, 95% CI 0.93-1.95) remained independent risk factors for major transfusions.
Discussion: Retained placenta and antenatal anemia (hemoglobin < 10 g/dL) are independent risk factors for major transfusion. Of these, anemia was found to be the most significant.
Keywords: anemia; case-control; delivery; hemorrhage; obstetrics; packed cells.
© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.