• Marie-Pierre Bonnet, Catherine Deneux-Tharaux, Corinne Dupont, Rene-Charles Rudigoz, and Marie-Helene Bouvier-Colle.
• INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Port Royal Maternity Unit, Cochin Teaching Hospital, Paris, France. marie-pierre.bonnet@inserm.fr
• Acta Obstet Gynecol Scand. 2013 Apr 1;92(4):404-13.

ObjectiveTo describe transfusion practices and anemia in women with postpartum hemorrhage (PPH), according to the clinical context.DesignPopulation-based cohort study.SettingA total of 106 French maternity units (146 781 deliveries, December 2004 to November 2006).PopulationAll women with PPH (n = 9365).MethodsDescription of the rate of red blood cell (RBC) transfusion in PPH overall and compared with transfusion guidelines.Main Outcome MeasuresTransfusion practices and postpartum anemia by mode of delivery and cause of PPH in women given RBCs within 12 h after PPH.ResultsA total of 701 women received RBCs (0.48 ± 0.04% of all women and 7.5 ± 0.5% of women with PPH). Half the women with clinical PPH and hemoglobin lower than 7.0 g/dL received no RBCs. In the group with clinical PPH and transfusion within 12 h (n = 426), operative vaginal delivery was associated with a larger maximal hemoglobin drop, more frequent administration of fresh-frozen plasma (FFP) and pro-hemostatic agents [odds ratio (OR) 3.54, 95% confidence interval (95% CI) 1.12-11.18], transfusion of larger volumes of RBCs and FFP, a higher rate of massive RBCs transfusion (OR 5.22, 95% CI 2.12-12.82), and more frequent use of conservative surgery (OR 3.2, 95% CI 1.34-7.76), compared with spontaneous vaginal delivery.ConclusionsThe RBC transfusion for PPH was not given in a large proportion of women with very low hemoglobin levels despite guidelines to the contrary. Operative vaginal delivery is characterized by higher blood loss and more transfusions than spontaneous vaginal delivery.© 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

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