• Mrinalini Balki, Sudhir Dhumne, Shilpa Kasodekar, Gareth Seaward, and Jose C A Carvalho.
• Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto ON.
• J Obstet Gynaecol Can. 2008 Nov 1;30(11):1002-7.

ObjectiveTo describe the common characteristics, clinical management, and outcome of patients requiring blood transfusion within 24 hours of delivery.MethodsWe conducted a retrospective cohort study of patients who received blood transfusion for postpartum hemorrhage (PPH) in the first 24 hours post-delivery, over a five-year period (2000-2005). The medical records of patients were reviewed to obtain information about demographics, pregnancy and delivery characteristics, transfusion data, and complications.ResultsThe overall blood transfusion rate for PPH was 0.31% (104/33,631 deliveries). The rate of blood transfusion in women who had a Caesarean section during labour was 0.49%, whereas in women who had a vaginal delivery or elective Caesarean section it was 0.28% and 0.23%, respectively. Antenatal risk factors for PPH were identified in 61% of patients, and 39% of patients developed intrapartum risk factors. The most important etiological factors were uterine atony (38.5%) and retained products of conception (33.7%). Twenty-one percent of the patients developed coagulopathy, and 24% required admission to the intensive care unit.ConclusionSevere primary PPH requiring blood transfusion can be predicted in the majority of patients on the basis of antenatal risk factors, while the remaining patients require vigilant monitoring for risk factors during labour and delivery. In the multidisciplinary effort to prevent and control major PPH, we should re-evaluate the pharmacotherapy for PPH and ensure careful removal of retained placental tissue after delivery.

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