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Obstetrics & Gynecology 2006;108:891-897
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Blood Transfusion and Cesarean Delivery

Dwight J. Rouse, MD, MSPH, Cora MacPherson, PhD, Mark Landon, MD, Michael W. Varner, MD, Kenneth J. Leveno, MD, Atef H. Moawad, MD, Catherine Y. Spong, MD, Steve N. Caritis, MD, Paul J. Meis, MD, Ronald J. Wapner, MD, Yoram Sorokin, MD, Menachem Miodovnik, MD, Marshall Carpenter, MD, Alan M. Peaceman, MD, Mary Jo O'Sullivan, MD, Baha M. Sibai, MD, Oded Langer, MD, John M. Thorp, MD, Susan M. Ramin, MD, Brian M. Mercer, MD for the National Institite of Child Health and Human Development Maternal–Fetal Medicine Units Network*

From the Departments of 1 Obstetrics and Gynecology, the University of Alabama at Birmingham, Birmingham, Alabama; the 2 George Washington University Biostatistics Center, Washington, DC; 3 Ohio State University, Columbus, Ohio; 4 University of Utah, Salt Lake City, Utah; 5 University of Texas Southwestern Medical Center, Dallas, Texas; 6 University of Chicago, Chicago, Illinois; 7 the National Institute of Child Health and Human Development, Bethesda, Maryland; 8 University of Pittsburgh, Pittsburgh, Pennsylvania; 9 Wake Forest University School of Medicine, Winston-Salem, North Carolina; 10 Thomas Jefferson University, Philadelphia, Pennsylvania; 11 Wayne State University, Detroit, Michigan; 12 University of Cincinnati, Cincinnati, Ohio; 13 Brown University, Providence, Rhode Island; 14 Northwestern University, Chicago, Illinois; 15 University of Miami, Miami, Florida; 16 University of Tennessee, Memphis, Tennessee; 17 University of Texas Health Science Center at San Antonio, San Antonio, Texas; 18 University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; 19 University of Texas Health Science Center at Houston, Houston, Texas; and 20 Case Western Reserve University, Cleveland, Ohio.

OBJECTIVE: To evaluate risks for intraoperative or postoperative packed red blood cell transfusion in women who underwent cesarean delivery.

METHODS: This was a 19-university prospective observational study. All primary cesarean deliveries from January 1, 1999, to December 31, 2000, and all repeat cesareans from January 1, 1999, to December 31, 2002, were included. Trained, certified research nurses performed systematic data abstraction. Primary and repeat cesarean deliveries were analyzed separately. Univariable analyses were used to inform multivariable analyses.

RESULTS: A total of 23,486 women underwent primary cesarean delivery, of whom 762 (3.2%) were transfused (median 2 units, 25th% to 75th% 2–3 units). A total of 33,683 women underwent primary cesarean delivery, and 735 (2.2%) were transfused (median 2 units, 25th% to 75th% 2–4 units). Among primary cesareans, general anesthesia (odds ratio [OR] 4.2, 95% confidence interval [CI] 3.5–5.0), placenta previa (OR 4.8, CI 3.5–6.5) and severe (hematocrit less than 25%) preoperative anemia (OR 17.0, CI 12.4–23.3) increased the odds of transfusion. Among repeat cesareans, the risk was increased by general anesthesia (OR 7.2, CI 5.9–8.7), a history of five or more prior cesareans (OR 7.6, CI 4.0–14.3), placenta previa (OR 15.9, CI 12.0–21.0), and severe preoperative anemia (OR 19.9, CI 14.5–27.2).

CONCLUSION: Overall, the risk of transfusion in association with cesarean is low. However, both severe preoperative maternal anemia and placenta previa are associated with markedly increased risks. The former argues for optimizing maternal antenatal iron status to avoid severe anemia and the latter for careful perioperative planning when previa complicates cesarean.

LEVEL OF EVIDENCE: II-2




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W. A. Grobman, R. Gersnoviez, M. B. Landon, C. Y. Spong, K. J. Leveno, D. J. Rouse, M. W. Varner, A. H. Moawad, S. N. Caritis, M. Harper, et al.
Pregnancy Outcomes for Women With Placenta Previa in Relation to the Number of Prior Cesarean Deliveries
Obstet. Gynecol., December 1, 2007; 110(6): 1249 - 1255.
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