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1. Risk factors for peripartum blood transfusion in South Africa: a case-control study

Author

Bloch, Evan M, Ingram, Charlotte, Hull, Jennifer, Fawcus, Susan, Anthony, John, Green-Thompson, Randolph, Crookes, Robert L, Ngcobo, Solomuzi, V Creel, Darryl, Courtney, Lauren, Bellairs, Greg RM, Murphy, Edward L, and South Africa Program of the NHLBI Recipient Epidemiology and Donor Evaluation Study-III (REDS-III)

Subjects
Adult, Adolescent, South Africa Program of the NHLBI Recipient Epidemiology and Donor Evaluation Study-III, Clinical Trials and Supportive Activities, Clinical Sciences, Immunology, HIV Infections, Gestational Age, Cardiorespiratory Medicine and Haematology, Health Services Accessibility, South Africa, Young Adult, Postoperative Complications, Hematologic, Risk Factors, Pregnancy, Clinical Research, Odds Ratio, Humans, Birth Weight, Blood Transfusion, Cesarean Section, Prevention, Postpartum Hemorrhage, Infectious, Infant, Anemia, Prenatal Care, Hematology, Newborn, Pregnancy Complications, Good Health and Well Being, Cardiovascular System & Hematology, Case-Control Studies, HIV/AIDS, Female, Infection
Abstract

BackgroundObstetric hemorrhage (OH) and access to peripartum blood transfusion remains a global health challenge. The rates of peripartum transfusion in South Africa exceed those in high-income countries despite comparable rates of OH. We sought to evaluate factors associated with peripartum transfusion.Study design and methodsA case-control study was conducted at four large South African hospitals. Transfused peripartum women (cases) and nontransfused controls were stratum matched 1:2 by hospital and delivery date. Data on obstetric, transfusion, and human immunodeficiency virus (HIV) history were abstracted from medical records. Blood was obtained for laboratory evaluation. We calculated unadjusted and adjusted odds ratios (ORs) for transfusion using logistic regression.ResultsA total of 1200 transfused cases and 2434 controls were evaluated. Antepartum hemorrhage (OR, 197.95; 95% confidence interval [CI], 104.27-375.78), hemorrhage with vaginal delivery (OR, 136.46; 95% CI, 75.87-245.18), prenatal anemia (OR, 22.76; 95% CI, 12.34-41.93 for prenatal hemoglobin level

Published
2018

2. Risk factors for peripartum blood transfusion in South Africa: a case-control study.

Author

Bloch, Evan M., Ingram, Charlotte, Hull, Jennifer, Fawcus, Susan, Anthony, John, Green‐Thompson, Randolph, Crookes, Robert L., Ngcobo, Solomuzi, V. Creel, Darryl, Courtney, Lauren, Bellairs, Greg R. M., Murphy, Edward L., for the South Africa Program of the NHLBI Recipient Epidemiology and Donor Evaluation Study‐III (REDS‐III), Green-Thompson, Randolph, and South Africa Program of the NHLBI Recipient Epidemiology and Donor Evaluation Study-III (REDS-III)

Subjects
BLOOD transfusion, OBSTETRICS, HIV, SURGERY, MEDICINE, HEMORRHAGE treatment, TREATMENT of surgical complications, HIV infection epidemiology, COMMUNICABLE disease epidemiology, ANEMIA, BIRTH weight, BLOOD diseases, CESAREAN section, COMPARATIVE studies, GESTATIONAL age, HEALTH services accessibility, HEMORRHAGE, RESEARCH methodology, MEDICAL cooperation, PREGNANCY complications, PRENATAL care, PUERPERAL disorders, RESEARCH, RESEARCH funding, SURGICAL complications, EVALUATION research, CASE-control method, ODDS ratio, THERAPEUTICS
Abstract

Background: Obstetric hemorrhage (OH) and access to peripartum blood transfusion remains a global health challenge. The rates of peripartum transfusion in South Africa exceed those in high-income countries despite comparable rates of OH. We sought to evaluate factors associated with peripartum transfusion.Study Design and Methods: A case-control study was conducted at four large South African hospitals. Transfused peripartum women (cases) and nontransfused controls were stratum matched 1:2 by hospital and delivery date. Data on obstetric, transfusion, and human immunodeficiency virus (HIV) history were abstracted from medical records. Blood was obtained for laboratory evaluation. We calculated unadjusted and adjusted odds ratios (ORs) for transfusion using logistic regression.Results: A total of 1200 transfused cases and 2434 controls were evaluated. Antepartum hemorrhage (OR, 197.95; 95% confidence interval [CI], 104.27-375.78), hemorrhage with vaginal delivery (OR, 136.46; 95% CI, 75.87-245.18), prenatal anemia (OR, 22.76; 95% CI, 12.34-41.93 for prenatal hemoglobin level < 7 g/dL), and failed access to prenatal care (OR, 6.71; 95% CI, 4.32-10.42) were the major risk factors for transfusion. Platelet (PLT) count (ORs, 4.10, 2.66, and 1.77 for ≤50 × 109 , 51 × 109 -100 × 109 , and 101 × 109 -150 × 109 cells/L, respectively), HIV infection (OR, 1.29; 95% CI, 1.02-1.62), and admitting hospital (twofold variation) were also associated with transfusion. Mode of delivery, race, age category, gravidity, parity, gestational age, and birthweight were not independently associated with transfusion.Conclusion: Major risk factors of peripartum transfusion in South Africa, namely, prenatal anemia and access to prenatal care, may be amenable to intervention. HIV infection and moderately low PLT count are novel risk factors that merit further investigation. [ABSTRACT FROM AUTHOR]

Published
2018
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