Blood transfusion and cesarean delivery

Dwight J. Rouse, Cora MacPherson, Mark Landon, Michael W. Varner, Kenneth J. Leveno, Atef H. Moawad, Catherine Y. Spong, Steve N. Caritis, Paul J. Meis, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Alan M. Peaceman, Mary Jo O'Sullivan, Baha M. Sibai, Oded Langer, John M. Thorp, Susan M. Ramin, Brian M. Mercer

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)891-897
Number of pages7
JournalObstetrics and Gynecology
Volume108
Issue number4
DOIs
StatePublished - Sep 1 2006
Externally publishedYes

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Blood Transfusion
Odds Ratio
Confidence Intervals
Placenta Previa
Anemia
General Anesthesia
Mothers
Erythrocyte Transfusion
Hematocrit
Observational Studies
Iron
Nurses
Prospective Studies
Research

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Rouse, D. J., MacPherson, C., Landon, M., Varner, M. W., Leveno, K. J., Moawad, A. H., ... Mercer, B. M. (2006). Blood transfusion and cesarean delivery. Obstetrics and Gynecology, 108(4), 891-897. https://doi.org/10.1097/01.AOG.0000236547.35234.8c

Blood transfusion and cesarean delivery. / Rouse, Dwight J.; MacPherson, Cora; Landon, Mark; Varner, Michael W.; Leveno, Kenneth J.; Moawad, Atef H.; Spong, Catherine Y.; Caritis, Steve N.; Meis, Paul J.; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; Carpenter, Marshall; Peaceman, Alan M.; O'Sullivan, Mary Jo; Sibai, Baha M.; Langer, Oded; Thorp, John M.; Ramin, Susan M.; Mercer, Brian M.

In: Obstetrics and Gynecology, Vol. 108, No. 4, 01.09.2006, p. 891-897.

Research output: Contribution to journalArticle

Rouse, DJ, MacPherson, C, Landon, M, Varner, MW, Leveno, KJ, Moawad, AH, Spong, CY, Caritis, SN, Meis, PJ, Wapner, RJ, Sorokin, Y, Miodovnik, M, Carpenter, M, Peaceman, AM, O'Sullivan, MJ, Sibai, BM, Langer, O, Thorp, JM, Ramin, SM & Mercer, BM 2006, 'Blood transfusion and cesarean delivery', Obstetrics and Gynecology, vol. 108, no. 4, pp. 891-897. https://doi.org/10.1097/01.AOG.0000236547.35234.8c
Rouse DJ, MacPherson C, Landon M, Varner MW, Leveno KJ, Moawad AH et al. Blood transfusion and cesarean delivery. Obstetrics and Gynecology. 2006 Sep 1;108(4):891-897. https://doi.org/10.1097/01.AOG.0000236547.35234.8c
Rouse, Dwight J. ; MacPherson, Cora ; Landon, Mark ; Varner, Michael W. ; Leveno, Kenneth J. ; Moawad, Atef H. ; Spong, Catherine Y. ; Caritis, Steve N. ; Meis, Paul J. ; Wapner, Ronald J. ; Sorokin, Yoram ; Miodovnik, Menachem ; Carpenter, Marshall ; Peaceman, Alan M. ; O'Sullivan, Mary Jo ; Sibai, Baha M. ; Langer, Oded ; Thorp, John M. ; Ramin, Susan M. ; Mercer, Brian M. / Blood transfusion and cesarean delivery. In: Obstetrics and Gynecology. 2006 ; Vol. 108, No. 4. pp. 891-897.
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abstract = "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.",
author = "Rouse, {Dwight J.} and Cora MacPherson and Mark Landon and Varner, {Michael W.} and Leveno, {Kenneth J.} and Moawad, {Atef H.} and Spong, {Catherine Y.} and Caritis, {Steve N.} and Meis, {Paul J.} and Wapner, {Ronald J.} and Yoram Sorokin and Menachem Miodovnik and Marshall Carpenter and Peaceman, {Alan M.} and O'Sullivan, {Mary Jo} and Sibai, {Baha M.} and Oded Langer and Thorp, {John M.} and Ramin, {Susan M.} and Mercer, {Brian M.}",
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T1 - Blood transfusion and cesarean delivery

AU - Rouse, Dwight J.

AU - MacPherson, Cora

AU - Landon, Mark

AU - Varner, Michael W.

AU - Leveno, Kenneth J.

AU - Moawad, Atef H.

AU - Spong, Catherine Y.

AU - Caritis, Steve N.

AU - Meis, Paul J.

AU - Wapner, Ronald J.

AU - Sorokin, Yoram

AU - Miodovnik, Menachem

AU - Carpenter, Marshall

AU - Peaceman, Alan M.

AU - O'Sullivan, Mary Jo

AU - Sibai, Baha M.

AU - Langer, Oded

AU - Thorp, John M.

AU - Ramin, Susan M.

AU - Mercer, Brian M.

PY - 2006/9/1

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N2 - 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.

AB - 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.

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