Criteria for transfusion in severe postpartum hemorrhage: analysis of practice and risk factors Fabien Reyal, Olivier Sibony * , Jean-Franc ¸ois Oury, Dominique Luton, Jacques Bang, Philippe Blot Ho ˆpital Robert Debre ´, 48 Boulevard Se ´rurier, 75019 Paris, France Received 6 August 2002; accepted 17 April 2003 Abstract Objective: To analyze the accuracy of postpartum hemorrhage risk factors to determine patients at risk of severe postpartum hemorrhage and transfusion. Population and methods: Retrospective cohort study from a database in one high-risk obstetric unit over a 7-year period. Results: In a cohort of 19,204 deliveries, 44 patients were transfused of whom five were given frozen fresh plasma only. Of the 39 who received red blood cells, 35 received at least three units. Multivariate analysis of postpartum hemorrhage risk factors revealed a significant role of placenta previa/accreta, cesarean section, multiple pregnancy, prematurity and vascular disease. Nevertheless 28% of women transfused had none of these risk factors. Conclusion: The percentage of patients transfused has probably decreased markedly with improved prevention, surveillance and treatment. This study emphasizes that the transfusion risk in the presence of anomalous placental insertion justifies special obstetrical and anesthetic management. # 2003 Published by Elsevier Ireland Ltd. Keywords: Transfusion; Postpartum hemorrhage; Risk factors 1. Introduction Human immunodeficiency virus, hepatitis B and C and more recently Prion diseases have led to major changes in blood transfusion practices despite clear improvements in the safety of biological products. The continuing risk of contamination complicates blood transfusion decisions, par- ticularly during pregnancy. Transfusion is one of the main tool for the treatment of severe postpartum hemorrhage. It’s a life-saving procedure and an important criteria of quality of care of pregnant women. We consider that severe post- partum hemorrhage is well defined by the use of postpartum transfusion. Its reduction can be analyzed as an amelioration of health care service. We describe here our transfusion practice associated with severe postpartum hemorrhage between 1992 and 1998 at the Robert Debre ´ University Teaching Hospital in Paris. We analyze the accuracy of postpartum hemorrhage risk factors to determine patients at risk of severe postpartum hemorrhage and transfusion. We speculate to our ability to reduce them by prevention methods. We discuss the opportunity to use predelivery blood ordering, auto-transfusion program or cell saver. 2. Materials and methods We conducted a retrospective cohort study of patients who gave birth between 1st January 1992 and 31st December 1998 at the maternity ward of the Robert Debre ´ University Teaching Hospital in Paris. Our unit is located in pediatrics hospital with neonatal intensive care unit and significant prenatal diagnosis activity. By this way, our patients com- pose a high risk population. For this purpose we used a database established using Microsoft Access 2000 (Micro- soft 1 ) and updated daily since 1992. The inclusion criteria were singleton or multiple pregnancy, delivery after 24 weeks of amenorrhea, transfusion of red blood cells and/ or frozen plasma in the 21 days following delivery in the presence of a hemorrhagic complication. The indications for transfusion in our department were identical to the United States guidelines: Acute blood loss of many amount if there is clinical evidence of inadequate oxygen-carrying capacity; a Hb of <7 g/dl (hematocrit of 0.21) if not due to a treatable cause; symptomatic anemia European Journal of Obstetrics & Gynecology and Reproductive Biology 112 (2004) 61–64 * Corresponding author. Tel.: þ33-140032454; fax: þ33-140032480. E-mail address: olivier.sibony@rdb.ap-hop-paris.fr (O. Sibony). 0301-2115/$ – see front matter # 2003 Published by Elsevier Ireland Ltd. doi:10.1016/j.ejogrb.2003.04.001