OBSTETRIC HEMORRHAGE AND BLOOD UTILIZATION

Patients on a busy obstetric service were prospectively evaluated to d etermine which ones required blood transfusion. During the period Janu ary-April 1990, 5,528 deliveries were performed. Fifty-five patients ( 0.99%) received blood transfusions during their pregnancy and puerperi um. The most common conditions associated with transfusion were trauma due to instrumental delivery (16), uterine atony (15), placenta previ a (12), retained products of conception (4), abruptio placentae (4) an d coagulopathy secondary to the HELLP syndrome (1). Platelets, fresh f rozen plasma, whole blood and cryoprecipitate were administered to 7, 6, 1 and 1 patients, respectively. The transfusion rates by procedure were emergency cesarean hysterectomy for bleeding placenta previa or a tony, 7/7 (100%); vacuum extraction, 7/114 (6.1%); forceps delivery, 1 21285 (4.2%); uncomplicated cesarean delivery, 10/704 (1.4%); and spon taneous vaginal birth, 19/4,425 (0.4%). The hemorrhage and subsequent need for a blood transfusion were not necessarily due to the procedure except in the case of trauma due to instrumental vaginal delivery. Th e rate of transfusion of red blood cells for patients undergoing vagin al instrumental delivery was significantly higher than the rate for th ose undergoing cesarean delivery (relative risk, 2.8; 95% confidence i nterval, 1.5-5.2). The need for transfusion can be anticipated on the basis of antepartum causes in only 23.7% of patients ultimately receiv ing blood products.