A reappraisal of the need for autologous blood donation in the obstetric patient

Article Abstract:

Autologous blood donation refers to the donation of one's own blood for use in subsequent transfusions; it is performed with increasing frequency because of people's fear that hepatitis or human immunodeficiency virus (HIV) could be transmitted via transfusion of donated blood. To evaluate whether autologous blood donation is a worthwhile option for obstetric patients, the transfusion frequency was reviewed for 2,265 deliveries at a large medical center over a six-month period. High-risk patients were a special focus of the investigation: these had a history of hemorrhage after delivery, anemia (lack of red blood cells), planned cesarean section, placenta previa (abnormal location of the placenta), previous delivery of many children, or multiple gestation (twins, triplets). Results showed that blood transfusion was required for 0.67 percent of the total cases (13 women); these occurred in 5 of 1,750 vaginal deliveries, 7 of 356 first-time cesarean sections, and 1 of 150 repeat cesarean sections. High-risk pregnancies were diagnosed in 251 women, of whom 4 (1.6 percent) needed transfusions. The high-risk pregnancies that needed transfusions comprised 1 of 150 (0.7 percent) delivered via repeat cesareans, 1 of 27 (3.7 percent) after multiple gestations, and 2 of 8 (25 percent) with placenta previa. None of the patients who had borne many children needed transfusions. Only two high-risk women would have been eligible for autologous donation, and almost all women who needed transfusions required several units of blood, rarely available via autologous donation. Based on these results, it seems that identification of risk factors for postpartum hemorrhage is not an accurate guide to the subsequent need for transfusion. A better alternative to guarantee the safety of an obstetrical population is to restrict the need for blood transfusion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Usage, Evaluation, Statistics, Blood transfusion, Uterine bleeding, Uterine hemorrhage, Blood transfusion, Autologous, Autologous blood transfusion, Labor, Complicated, Labor complications

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Vaginal birth after cesarean section: a reappraisal of risk

Article Abstract:

Many practitioners maintain that once a woman has had a cesarean delivery, all subsequent pregnancies will require cesarean section whether it is obstetrically indicated or not. Vaginal delivery after a previous cesarean section is now performed more often and may actually reduce the risk of maternal complications. To determine if there are any complications associated with vaginal delivery after cesarean section, a review was conducted of all the birth records in a naval hospital over a 36 month period. Of the 224 vaginal deliveries attempted after a previous cesarean section, 66.16 percent successfully delivered. However, the patients who had a vaginal delivery after a cesarean section sustained more vaginal tears than patients not having had a previous cesarean. The uterine scar of a previous cesarean section separated during vaginal delivery in 1.79 percent of the cases; one patient required a hysterectomy. This complication was higher than previous reports of 0.05 percent. Two infant deaths were reported, but not attributed to the birthing process. Fetal mortality during delivery was estimated at 8.93 out of 1000 births. Patients considering vaginal delivery after cesarean section should be counseled regarding the increased risk for vaginal tears.

Patient outcomes, Mortality, Comparative analysis, Childbirth, Delivery (Childbirth), Labor (Obstetrics)

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Rising cesarean delivery rate in primiparous women in urban China: Evidence from three nationwide household health surveys

Article Abstract:

The trend in the rate of d in primiparous women is examined and individual socioeconomic factors driving the escalation of cesarean delivery rates in urban China are analyzed. Results indicate that many nonmedical causes related to individual social and economic factors might have played an important role in the rapid rise of cesarean delivery rates.

China, Reports, Clinical report

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