What is the relationship between blood transfusion and serious maternal morbidity, as reported by the Centers for Disease Control and Prevention (CDC)?

From the Guidelines

Blood transfusions are a critical and potentially life-saving intervention in cases of serious maternal morbidity, as tracked by the CDC, and should be administered promptly when a pregnant or postpartum woman experiences severe blood loss or shows signs of hemodynamic instability, as supported by the most recent guidelines and evidence 1.

Key Considerations for Blood Transfusions in Maternal Morbidity

• The decision to transfuse blood products should be based on the severity of blood loss and the patient's clinical condition, with a focus on preventing further complications or death.
• The CDC monitors blood transfusion as one of the key indicators of severe maternal morbidity, highlighting its importance in maternal care.
• Healthcare providers should be aware of the risk factors for hemorrhage, such as placenta previa, prior cesarean delivery, or coagulation disorders, to prepare for potential transfusion needs.
• The process of blood transfusion involves administering packed red blood cells, fresh frozen plasma, platelets, or cryoprecipitate, depending on the specific needs of the patient.
• Patient monitoring is essential during the transfusion episode to identify and manage adverse reactions, with a focus on respiratory rate, pulse, blood pressure, and temperature.

Recent Guidelines and Evidence

• The Association of Anaesthetists guidelines emphasize the importance of positive patient identification prior to blood transfusion, as well as the need for careful monitoring of patients during the transfusion process 1.
• The guidelines also highlight the risk of transfusion-associated circulatory overload (TACO), which is now the most common cause of transfusion-related mortality and major morbidity.
• The CDC's surveillance of transfusion-related maternal morbidity helps identify patterns and improve maternal care protocols nationwide, as reported in recent studies 1.

Clinical Implications

• Healthcare providers should prioritize the administration of blood transfusions in cases of severe maternal morbidity, while also being aware of the potential risks and complications associated with transfusion.
• The use of massive transfusion protocols, such as a ratio of 1:1:1 (red cells:plasma:platelets), may be necessary in cases of severe hemorrhage.
• Early recognition of hemorrhage risk factors and prompt intervention can help improve outcomes for pregnant and postpartum women experiencing severe blood loss.

From the Research

Blood Transfusion and Serious Maternal Morbidity

• Blood transfusion is a critical aspect of managing serious maternal morbidity, particularly in cases of postpartum hemorrhage 2, 3, 4.
• The risk of blood transfusion is higher in women undergoing cesarean section, especially in cases of placenta previa, placental abruption, and emergency cesarean section 5.
• A systematic review and meta-analysis found that placenta previa, placental abruption, emergency C-section, general anesthesia, multiple gestations, preterm labor, prolonged labor, unbooked cases, hypertensive disorders of pregnancy, and fibroids were significantly associated with an increased risk of blood transfusion in C-section 5.

Risk Factors for Blood Transfusion

• Preoperative autologous blood donation (PAD) has been shown to be safe and effective in avoiding allogeneic blood transfusion in pregnant women at high risk of massive hemorrhage 6.
• The use of quantitative measurement of blood loss has been found to be associated with an increased rate of red blood cell transfusion compared to visual estimation of blood loss 2.
• A study found that the rate of excess blood loss increased in low-risk cases in 2006 compared with 1996, possibly due to the recommended restricted intra-operative oxytocin dose 3.

Trends in Blood Transfusion Rates

• The rate of blood transfusion has been found to be increasing over time, with a study showing a 33% increase in obstetric blood product transfusion since 2001 4.
• Another study found that the transfusion rate increased steadily from 1.2% in 2001 to 1.6% in 2010 4.
• The majority of transfusions (91%) occurred during the birth admission, and 81% of these transfusions were associated with a diagnosis of hemorrhage 4.