Blood transfusion in patients having caesarean section: a prospective multicentre observational study of practice in three Pakistan hospitals.
BACKGROUND
Increasing awareness of the risks of blood transfusion has prompted examination of red cell transfusion practice in obstetrics. A six-month prospective observational study was performed to examine blood transfusion practices in patients undergoing caesarean delivery at three hospitals in Pakistan.


METHODS
In the three hospitals (two private, one public) 3438 caesarean deliveries were performed in the study period. Data were collected on patient demographics, indications for transfusion, ordering physicians, consent, associations with obstetric factors, estimated allowable blood loss, calculated blood loss, pre- and post-transfusion haemoglobin and discharge haemoglobin.


RESULTS
A total number of 397 (11.5%) patients who underwent caesarean section received a blood transfusion. The highest transfusion rate of 16% was recorded in the public tertiary care hospital compared to 5% in the two private hospitals. Emergency caesarean delivery and multiparity were associated with blood transfusion (P<0.05). More emergency caesarean sections were performed in the public compared to the private hospitals (85.4% vs. 41.6%). More multiparous patients underwent caesarean section in the public hospital (57.8% vs. 40.4%). Attending physicians took the decision for transfusion in 98% of cases. In 343 (86%) patients, blood transfusion was given even when the haemoglobin was >7g/dL. The method for documenting the indication or consent for transfusion was not found in any of the three hospitals.


CONCLUSIONS
Blood transfusion was prescribed more readily in the public hospital. Identification of a transfusion trigger and the development of institutional guidelines to reduce unnecessary transfusion are required.
Department of Anaesthesia, Aga Khan University Hospital, Karachi, Pakistan. Electronic address: samina.ismail@aku.edu.
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Ismail
Department of Anaesthesia, SICU and Pain Management, Dow Medical College and Civil Hospital, Karachi, Pakistan.
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Siddiqui
Department of Anaesthesia, Aga Khan University Hospital, Karachi, Pakistan.
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Shafiq
Department of Anaesthesia and SICU, Shalamar Medical and Dental College, Lahore, Pakistan.
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Ishaq
Department of Anaesthesia, Aga Khan University Hospital, Karachi, Pakistan.
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Khan
D000328:Adult; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000379:methods*; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006400:Hematocrit; D006452:Hemoglobinometry; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D007744:Obstetric Labor Complications / Q000628:therapy; D010154:Pakistan; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011446:Prospective Studies
Blood transfusion practices; Caesarean section; Private sector hospitals; Public sector hospitals; Red cell transfusion