BACKGROUND: It is beyond doubt that blood transfusion services have added to the decline in maternal mortality in high-resource countries. To quantify the clinical benefit of red blood cell (RBC) transfusion in obstetric care, we performed a hypothetical experimental study using data from a prospective nationwide cohort of women giving birth in the Netherlands. STUDY DESIGN AND METHODS: Data were abstracted from a nationwide cohort study on severe maternal morbidity, including obstetric haemorrhage requiring 4 or more units of RBC, to obtain an observed and a hypothetical control group consisting of the same women. In the hypothetical control group, we simulated a situation where RBC transfusion was unavailable and estimated how many of these women would have died in that situation. A questionnaire survey asked experts in major (obstetric) haemorrhage to choose a critical minimal number of RBC transfusions at which a woman with obstetric haemorrhage would have died if RBC transfusion was not available. Maternal mortality rate per 100,000 maternities [maternal mortality ratios (MMR)] and relative risk were calculated for the observed and hypothetical group. RESULTS: The observed MMR was 13 per 100,000 maternities. According to 47 responding experts, the median number of RBC units without which a woman would have most probably died was nine, resulting in a hypothetical MMR of 87 per 100,000 maternities (relative risk 6·5; 95% confidence interval 4·2-10·0). CONCLUSIONS: It can be expected that unavailability of RBC transfusion in obstetric care increases the risk of maternal death 6.5-fold. Blood transfusion thus largely contributes to the decline of MMR and would also be an important pillar of improving quality of care in resource-poor settings.
BACKGROUND: It is beyond doubt that blood transfusion services have added to the decline in maternal mortality in high-resource countries. To quantify the clinical benefit of red blood cell (RBC) transfusion in obstetric care, we performed a hypothetical experimental study using data from a prospective nationwide cohort of women giving birth in the Netherlands. STUDY DESIGN AND METHODS: Data were abstracted from a nationwide cohort study on severe maternal morbidity, including obstetric haemorrhage requiring 4 or more units of RBC, to obtain an observed and a hypothetical control group consisting of the same women. In the hypothetical control group, we simulated a situation where RBC transfusion was unavailable and estimated how many of these women would have died in that situation. A questionnaire survey asked experts in major (obstetric) haemorrhage to choose a critical minimal number of RBC transfusions at which a woman with obstetric haemorrhage would have died if RBC transfusion was not available. Maternal mortality rate per 100,000 maternities [maternal mortality ratios (MMR)] and relative risk were calculated for the observed and hypothetical group. RESULTS: The observed MMR was 13 per 100,000 maternities. According to 47 responding experts, the median number of RBC units without which a woman would have most probably died was nine, resulting in a hypothetical MMR of 87 per 100,000 maternities (relative risk 6·5; 95% confidence interval 4·2-10·0). CONCLUSIONS: It can be expected that unavailability of RBC transfusion in obstetric care increases the risk of maternal death 6.5-fold. Blood transfusion thus largely contributes to the decline of MMR and would also be an important pillar of improving quality of care in resource-poor settings.
Authors: O T Oladapo; O O Adetoro; B A Ekele; C Chama; S J Etuk; A P Aboyeji; H E Onah; A M Abasiattai; A N Adamu; O Adegbola; A S Adeniran; C O Aimakhu; O Akinsanya; L D Aliyu; A B Ande; A Ashimi; M Bwala; A Fabamwo; A D Geidam; J I Ikechebelu; J O Imaralu; O Kuti; D Nwachukwu; L Omo-Aghoja; K Tunau; J Tukur; Ouj Umeora; A C Umezulike; O A Dada; Ӧ Tunçalp; J P Vogel; A M Gülmezoglu Journal: BJOG Date: 2015-05-14 Impact factor: 6.531
Authors: Tom Witteveen; Hans Bezstarosti; Ilona de Koning; Ellen Nelissen; Kitty W Bloemenkamp; Jos van Roosmalen; Thomas van den Akker Journal: BMC Pregnancy Childbirth Date: 2017-06-19 Impact factor: 3.007
Authors: Paul I Ramler; Thomas van den Akker; Dacia D C A Henriquez; Joost J Zwart; Jos van Roosmalen Journal: BMC Pregnancy Childbirth Date: 2017-06-19 Impact factor: 3.007
Authors: Tom Witteveen; Athanasios Kallianidis; Joost J Zwart; Kitty W Bloemenkamp; Jos van Roosmalen; Thomas van den Akker Journal: BMC Pregnancy Childbirth Date: 2018-02-27 Impact factor: 3.007