Background: Blood transfusion practices is an important topic that may significantlyreduce maternal mortality and morbidity. This study assessed the incidence, demographics,obstetric profile, and indications of transfusion of blood products among women admitted forobstetric care, in a tertiary care hospital.

Methods: This Cross-sectional study at Southern Railway Head Quarters hospital, Perambur, Chennai was conducted with women requiring services of obstetrics who were transfused with any blood product for obstetric care in the antenatal, intrapartum, and postpartum period. A total of 2375 women received obstetric care during the study period and were included in the final analysis and during an eighteen-month period (December 2017 – May 2019). Patients were given an information sheet and informed consent was obtained before the transfusions. Incidence of transfusion was recorded as the primary outcome variable.

Results: The incidence of blood transfusions was 57 (2.4%) out of a total of 2375 obstetric admissions. The mean age was 27.07 ± 3.87, the minimum age was 18 years and the maximum age was 37 years in the study population. Among the study population, 24 (42.10%) were primigravida and 33 (57.90%) participants were multigravida; 21 (36.84%) required transfusion in antepartum period, 6 (10.52%) required transfusion in intrapartum period and 30 (52.64%) participants required transfusion in post-partum period.The mean Hemoglobin (Hb) was 8.93 ± 1.88 in the study population, the minimum level was 4.30 and the maximum level was 13.20 in the study population and 57.69% were with 7-10 g/dl Hb. The proportion of people with < 7g/dl and >10g/dl Hb was 19.23% and 29.8% respectively.The commonest transfusion indication was post-partum hemorrhage (PPH) in 23 cases (40.35%). This was followed by 21 (36.84%) cases were due to anemia, 7 (12.3%) were due to antepartum hemorrhage (APH), 5 (8.77%) were due to ectopic pregnancies, 3 (5.26%) were due to abortions, 8 (14.04%) were due to hypertensive disorders of pregnancy, 1 (1.75%) was due to obstetric hysterectomy, 1 (1.75%) was due to DIC, 2 (3.51%) were due to gestational thrombocytopenia and 5 (9.43%) were due to medical disorders complicating pregnancy like dengue fever, immune thrombocytopenic purpura, systemic lupus erythematosus, and APLA syndrome. Sub analyses were conducted into the causes of PPH, anemia, and APH were alsodone; among those who had PPH, 13 (56.5%) were due to uterine atony, 8 (34.7%) due to genital tract trauma, and 2 (8.69%) due to retained products of conception.15 patients (26.79%) had an elective mode of transfusion and 42 (73.68%) participants had an emergency mode of transfusion. Types of transfusion ranged with 63.16% being PRBC transfusion, 47.37% were whole blood transfusion, 14.04% were random donor platelets and 10.53% were fresh frozen plasma. Mean post-transfusion Hb was 9.85 ± 0.96 in the study population, the minimum level was 7.30 and the maximum level was 12.40. Thus, 8.9 g/dl was the pre-transfusion Hb and 9.8% was the post-transfusion Hb.

Conclusions: During the study period, 2.4% of women required blood transfusions. PPH followed by anemia complicating pregnancy were the commonest causes of transfusion necessity. The indications noted in the study are comparable to existing studies. A standardization of transfusion protocols and guidelines would aid in identifying indications for blood use, triggers for transfusion, and ensuring women’s nutritional needs are met to reduce transfusion necessity in preventable causes.

IMAGE 1: Summary of Transfusion Indications in the Cross-sectional study at a tertiary care center.

IMAGE 2: Incidence of Blood transfusion requirement in the Cross-sectional study at a tertiary care center