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Massive blood transfusion during hospitalization for delivery in New York State, 1998-2007
Open accessAbstract
OBJECTIVE: To define the frequency, risk factors, and outcomes of massive transfusion in obstetrics. METHODS: The State Inpatient Dataset for New York (1998-2007) was used to identify all delivery hospitalizations for hospitals that reported at least one delivery-related transfusion per year. Multivariable logistic regression analysis was performed to examine the relationship between maternal age, race, and relevant clinical variables and the risk of massive blood transfusion defined as 10 or more units of blood recorded. RESULTS: Massive blood transfusion complicated 6 of every 10,000 deliveries with cases observed even in the smallest facilities. Risk factors with the strongest independent associations with massive blood transfusion included abnormal placentation (1.6/10,000 deliveries, adjusted odds ratio [OR] 18.5, 95% confidence interval [CI] 14.7-23.3), placental abruption (1.0/10,000, adjusted OR 14.6, 95% CI 11.2-19.0), severe preeclampsia (0.8/10,000, adjusted OR 10.4, 95% CI 7.7-14.2), and intrauterine fetal demise (0.7/10,000, adjusted OR 5.5, 95% CI 3.9-7.8). The most common etiologies of massive blood transfusion were abnormal placentation (26.6% of cases), uterine atony (21.2%), placental abruption (16.7%), and postpartum hemorrhage associated with coagulopathy (15.0%). A disproportionate number of women who received a massive blood transfusion experienced severe morbidity including renal failure, acute respiratory distress syndrome, sepsis, and in-hospital death. CONCLUSION: Massive blood transfusion was infrequent, regardless of facility size. In the presence of known risk for receipt of massive blood transfusion, women should be informed of this possibility, should deliver in a well-resourced facility if possible, and should receive appropriate blood product preparation and venous access in advance of delivery. LEVEL OF EVIDENCE: : II.
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“In a large retrospective cohort study that included all delivery hospitalizations for hospitals that reported at least one delivery-related transfusion per year in New York (1998–2007), massive transfusion occurred in 6 per 10,000 deliveries, and abruption was a strong independent risk factor (occurring in 1 per 10,000 deliveries; adjusted OR 14.6, 95% CI 11.2–19.0) (80).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [80]
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Abnormal placentation: Twenty-year analysis
Wu, S., Kocherginsky, M., & Hibbard, J. U. (2005) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2004.12.074 · Cited by 1,331
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The Epidemiology of Postpartum Hemorrhage in a Large, Nationwide Sample of Deliveries
Bateman, B. T., Berman, M. F., Riley, L. E., & Leffert, L. R. (2010) · Anesthesia & Analgesia · doi:10.1213/ane.0b013e3181d74898 · Cited by 668
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Trends in postpartum hemorrhage: United States, 1994–2006
Callaghan, W. M., Kuklina, E. V., & Berg, C. J. (2010) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2010.01.011 · Cited by 516
Kuklina, E. V., Whiteman, M. K., Hillis, S. D., Jamieson, D. J., Meikle, S., Posner, S. F., & Marchbanks, P. A. (2007) · Maternal and Child Health Journal · doi:10.1007/s10995-007-0256-6 · Cited by 488
Faiz, A. S., & Ananth, C. V. (2003) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/jmf.13.3.175.190 · Cited by 395
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Severe Obstetric Morbidity in the United States: 1998–2005
Kuklina, E. V., Meikle, S., Jamieson, D. J., Whiteman, M. K., Barfield, W. D., Hillis, S. D., & Posner, S. F. (2009) · Obstetrics and Gynecology · doi:10.1097/aog.0b013e3181954e5b · Cited by 211
Shields, L. E., Smalarz, K., Reffigee, L., Mugg, S., Burdumy, T. J., & Propst, M. (2011) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2011.06.084 · Cited by 206
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Practice Bulletin No. 183: postpartum hemorrhage
(2017) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000002351 · Cited by 1,406
Social Determinants of Pregnancy-Related Mortality and Morbidity in the United States
Wang, E., Glazer, K. B., Howell, E. A., & Janevic, T. M. (2020) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000003762 · Cited by 373
Risk factors for severe postpartum hemorrhage: a case-control study
Nyfløt, L. T., Sandven, I., Stray‐Pedersen, B., Pettersen, S., Al‐Zirqi, I., Rosenberg, M., Jacobsen, A. F., & Vangen, S. (2017) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-016-1217-0 · Cited by 315
Shields, L. E., Wiesner, S., Fulton, J., & Pelletreau, B. (2015) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2014.07.012 · Cited by 276
Grantz, K. L., Shenassa, E. D., & Downes, K. L. (2017) · American Journal of Perinatology · doi:10.1055/s-0037-1599149 · Cited by 168
Metadata
- Authors
- Mhyre, J. M., Shilkrut, A., Kuklina, E. V., Callaghan, W. M., Creanga, A. A., Kaminsky, S., & Bateman, B. T.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Obstetrics & Gynecology
- Published
- 2013-12
- Volume
- 122
- Issue
- 6
- Pages
- 1288-1294
- ISSN
- 0029-7844 (ISSN-L)
- PMC
- PMC4547558
- OpenAlex
- W2080957457
- Cited by
- 121
- References
- 23
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 6 · 2023: 13 · 2022: 11 · 2021: 14 · 2020: 10 · 2019: 14 · 2018: 8 · 2017: 14 · 2016: 7 · 2015: 11 · 2014: 6
- FWCI
- 7.45
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Touro Scholar (Touro College) (submittedVersion)
- Funders
- National Institutes of Health (CC999999)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Hematology › Blood transfusion and management
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
- Keywords
- massive transfusion, obstetric hemorrhage, postpartum hemorrhage, placental abruption, abnormal placentation, severe preeclampsia, intrauterine fetal death, uterine atony, coagulopathy, risk factors, maternal morbidity, in-hospital mortality, New York State
- MeSH terms
- Adult, Blood Coagulation Disorders, Blood Transfusion, Cross-Sectional Studies, Female, Fetal Death, Postpartum Hemorrhage, Humans, New York, Placenta Diseases, Pre-Eclampsia, Pregnancy, Retrospective Studies, Risk Factors, Uterine Inertia, Delivery, Obstetric, Young Adult, Transfusion Reaction
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