Department of Anesthesiology, Qilu Hospital of Shangdong University, 107 Wenhua Xi Road, Jinan, Shandong, China.
Medicine (Baltimore). 2021 Jan 22;100(3):e23885. doi: 10.1097/MD.0000000000023885.
Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and death worldwide. The history of cesarean section and the occurrence of placenta previa were significantly associated with the increase in blood transfusion. Therefore, to prevent PPH, it is important to understand the effect of blood transfusion during cesarean section on postpartum hemorrhage. The purpose of this study is to determine the cause of blood transfusion during cesarean section, especially large amounts of blood transfusion, and to take measures to reduce the blood demand caused by PPH with limited blood supply.This study was a retrospective study of patients who underwent blood transfusion during cesarean section in Qilu Hospital of Shandong University (China) from January 2013 to December 2016. Red blood cell infusion ≥10 U during cesarean section was defined as massive blood transfusion. The study collected the demographics of pregnant women, obstetric characteristics and reasons for blood transfusions, as well as blood components and blood transfusion results. Multivariate regression analysis was performed for evaluating the risk factors of PPN.From 2013 to 2016, a total of 587 patients received blood transfusions during cesarean section. The proportion of women receiving blood transfusion during cesarean section increased (from 3.21% to 7.40%, P < .001). The history of cesarean section (P = .005) and the occurrence of placenta previa were positively correlated with the increase in blood transfusion (P = .016). There were 72 cases of massive blood transfusion, accounting for 12.27% of blood transfusion patients. Among mass blood transfusions, 93.1% of cases had prior cesarean delivery, and placenta previa accounted for 95.8%. 19.4% of patients receiving massive blood transfusions underwent hysterectomy. There was no significant difference in maternal BMI and gestational age between the mass blood transfusion group and the non-mass blood transfusion group.From 2013 to 2016, the demand for blood transfusion, especially the demand for massive blood transfusion, increased. Repeated cesarean section and placental previa combined with uterine scar are positively correlated with increased blood transfusion. Reducing the initial cesarean section should help reduce the massive blood transfusion caused by placenta previa with a history of cesarean section.
产后出血（PPH）是全世界产妇发病和死亡的主要原因。剖宫产史和前置胎盘的发生与输血的增加有显著相关性。因此，预防 PPH 很重要，要了解剖宫产术中输血对产后出血的影响。本研究的目的是确定剖宫产术中输血的原因，特别是大量输血的原因，并采取措施在有限的血源下减少因 PPH 导致的血液需求。
本研究是对 2013 年 1 月至 2016 年 12 月在山东大学齐鲁医院（中国）行剖宫产术并输血的患者进行的回顾性研究。剖宫产术中输注红细胞≥10U 定义为大量输血。研究收集了孕妇的人口统计学资料、产科特征和输血原因，以及血液成分和输血结果。采用多变量回归分析评估 PPH 的危险因素。
2013 年至 2016 年，共有 587 例患者在剖宫产术中输血。行剖宫产术并输血的患者比例增加（从 3.21%增至 7.40%，P<0.001）。剖宫产史（P=0.005）和前置胎盘的发生与输血的增加呈正相关（P=0.016）。大量输血 72 例，占输血患者的 12.27%。在大量输血中，93.1%的病例有剖宫产史，95.8%的病例为前置胎盘。95.8%的患者行子宫切除术。大量输血组和非大量输血组产妇 BMI 和孕周无显著差异。
2013 年至 2016 年，输血需求，特别是大量输血需求增加。重复剖宫产和合并子宫瘢痕的前置胎盘与输血增加呈正相关。减少初次剖宫产有助于减少因剖宫产史和前置胎盘导致的大量输血。
