Obstetric Quality and Safety
Poster Session 3
Douglas S. Richards, MD
Intermountain Healthcare
Murray, UT, United States
Sarah Illstrup, MD
Medical Director Blood Transfusion Services
Intermountain Healthcare
Murray, UT, United States
Terry Rees, N/A
Transfusion Service
Intermountain Healthcare
Murray, UT, United States
Sean Esplin, MD (he/him/his)
Professor
Intermountain Medical Center
Murray, UT, United States
Donna Dizon-Townson, MD
Intermountain Health
Sandy, UT, United States
Erick Henry, MPH
Data Analytics Manager
Intermountain Health
Murray, UT, United States
Allison Butler, MS
Intermountain Healthcare
Murray, UT, United States
Brett D. Einerson, MD, MPH (he/him/his)
Assistant Professor, Director of The Utah Placenta Accreta Program
University of Utah Health
Salt Lake City, UT, United States
Maximum surgical blood order schedules (MSBO) recommend T&S if the need for transfusion during an operative procedure is predicted to be > 5%. The type of blood bank preparation ordered for women giving birth (hold clot, type and screen, or crossmatch) is often determined according to the presence of hemorrhage risk factors. This approach does not quantify the chance for transfusion. The purpose of this study was to quantify the relative importance of risk factors for needing a blood transfusion and to develop a formula to define each individual’s risk. This could then be used to decide an appropriate level of blood preparation for patients at different risk levels.
Study Design:
Risk factors for hemorrhage and the level of blood bank preparation were extracted from the medical records of a cohort of 89,239 women delivering in an 18-hospital health care system over 40 months. We tabulated the number who required at least one RBC transfusion or an urgent transfusion- defined as receiving blood during labor or within 4 hours after delivery. Odds ratios for requiring a transfusion were calculated for each risk factor. We then calculated the probability of a transfusion in deciles according to predicted risk of transfusion.
Results:
On admission, 66.3% of patients had a hold clot, 33.0% had a type and screen, and 0.7% had a crossmatch. 648 patients had any transfusion during their hospitalization (0.73% of deliveries), and 313 had an urgent transfusion (0.35% of deliveries). Odds ratios and frequency of risk factors are shown in the table. The mean probability of patients in the highest risk decile of having any transfusion was 3.4% (95% CI 3.0-3.8%).
Conclusion:
In our cohort, the lowest 9 deciles risk of transfusion was < 1%, and even the highest risk decile had a predicted transfusion risk well below 5%. Based on the low chance of needing a transfusion for almost all obstetric patients, we suggest that a hold clot be used except for the highest risk patients- i.e. those with PAS, Hgb < 8, or placenta previa.