title: Criteria for transfusion in severe postpartum hemorrhage: analysis of practice and risk factors.
abstract: OBJECTIVE
  To analyze the accuracy of postpartum hemorrhage risk factors to determine patients at risk of severe postpartum hemorrhage and transfusion.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Reyal
authors.forename: Olivier
authors.initials: O
authors.lastname: Sibony
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Oury
authors.forename: Dominique
authors.initials: D
authors.lastname: Luton
authors.forename: Jacques
authors.initials: J
authors.lastname: Bang
authors.forename: Philippe
authors.initials: P
authors.lastname: Blot
mesh_terms: D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D001803:Blood Transfusion / Q000592:standards* / Q000639:trends; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D015999:Multivariate Analysis; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome