The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, New South Wales, Australia.
Northern Sydney Local Health District, Kolling Institute, St Leonards, New South Wales, Australia.
BMC Pregnancy Childbirth. 2021 Sep 13;21(1):620. doi: 10.1186/s12884-021-04091-y.
Guidelines recommend that women at high risk of postpartum haemorrhage deliver at facilities able to handle heavy bleeding. However postpartum haemorrhage is often unexpected. This study aims to compare outcomes and health service use related to transfusion of ≥4 units of red blood cells between women delivering in tertiary and lower level hospitals.
The study population was women giving birth in public hospitals in New South Wales, Australia, between July 2006 and December 2010. Data were obtained from linked hospital, birth and blood bank databases. The exposure of interest was transfusion of four or more units of red cells during admission for delivery. Outcomes included maternal morbidity, length of stay, neonatal morbidity and need for other blood products or transfer to higher care. Multivariable regression models were developed to predict need of transfusion of ≥4 units of red cells using variables known early in pregnancy and those known by the birth admission.
Data were available for 231,603 births, of which 4309 involved a blood transfusion, with 1011 (0.4%) receiving 4 or more units. Women giving birth in lower level and/or smaller hospitals were more likely to receive ≥4 units of red cells. Women receiving ≥4 units in tertiary settings were more likely to receive other blood products and have longer hospital stays, but morbidity, readmission and hysterectomy rates were similar. Although 46% of women had no identifiable risk factors early in pregnancy, 20% of transfusions of ≥4 units occurred within this group. By the birth admission 70% of women had at least one risk factor for requiring ≥4 units of red cells.
Overall outcomes for women receiving ≥4 units of red cells were comparable between tertiary and non-tertiary facilities. This is important given the inability of known risk factors to predict many instances of postpartum haemorrhage.
指南建议有产后大出血高危风险的妇女在能够处理大出血的医疗机构分娩。然而，产后出血往往是意料之外的。本研究旨在比较在三级和较低级别医院分娩的妇女之间与输注≥4 单位红细胞相关的结局和卫生服务利用。
研究人群为 2006 年 7 月至 2010 年 12 月期间在澳大利亚新南威尔士州公立医院分娩的妇女。数据来自医院、分娩和血库数据库的链接。感兴趣的暴露是分娩期间输注≥4 单位红细胞。结局包括产妇发病率、住院时间、新生儿发病率以及是否需要其他血液制品或转至更高护理。使用妊娠早期已知的变量和分娩入院时已知的变量，开发了多变量回归模型来预测是否需要输注≥4 单位的红细胞。
共获得 231603 例分娩数据，其中 4309 例涉及输血，1011 例（0.4%）接受了≥4 单位红细胞。在较低级别和/或较小医院分娩的妇女更有可能接受≥4 单位的红细胞。在三级医院接受≥4 单位红细胞的妇女更有可能接受其他血液制品并住院时间更长，但发病率、再入院率和子宫切除术率相似。尽管 46%的妇女在妊娠早期没有明确的风险因素，但≥4 单位红细胞的输血中有 20%发生在该组。在分娩入院时，70%的妇女至少有一种需要输注≥4 单位红细胞的风险因素。
在三级和非三级设施中，接受≥4 单位红细胞的妇女的总体结局相似。考虑到已知的风险因素无法预测许多产后出血的情况，这一点很重要。
