• 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, and National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.
• Department of Obstetrics, the University of Alabama at Birmingham, Birmingham, Alabama 35249-7333, USA. drouse@uab.edu
• Obstet Gynecol. 2006 Oct 1; 108 (4): 891-7.

ObjectiveTo evaluate risks for intraoperative or postoperative packed red blood cell transfusion in women who underwent cesarean delivery.MethodsThis 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.ResultsA 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 repeat [corrected] 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).ConclusionOverall, 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 EvidenceII-2.

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