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Incidence, trends and risk factors for obstetric massive blood transfusion in China from 2012 to 2019: an
Yanxia Xie1, Juan Liang1,2, Yi Mu1
1National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China.
Insights
Obstetric massive blood transfusion (MBT) incidence increased in China from 2012-2019, linked to factors like uterine atony and advanced maternal age. However, hysterectomy and maternal mortality rates decreased among MBT patients.
Area of Science:
- Obstetrics and Gynecology
- Transfusion Medicine
- Public Health Surveillance
Background:
- Massive blood transfusion (MBT) in obstetrics is a critical indicator of severe maternal morbidity.
- Understanding the epidemiology and risk factors of obstetric MBT is crucial for improving maternal outcomes.
- China's National Maternal Near Miss Surveillance System (NMNMSS) provides valuable data for national health studies.
Purpose of the Study:
- To determine the incidence and trends of obstetric massive blood transfusion (MBT) in China from 2012 to 2019.
- To identify the key risk factors and associated conditions leading to obstetric MBT.
- To evaluate the clinical outcomes, including hysterectomy and maternal mortality, for women undergoing MBT.
Main Methods:
- An observational study utilizing data from China's National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2019.
- Inclusion of 11,667,406 hospitalised pregnancies.
- Analysis of MBT incidence (≥5 units RBC or ≥1000 mL whole blood per 10,000 maternities), trends, risk factors, and outcomes (hysterectomy, maternal mortality ratio).
Main Results:
- The incidence of obstetric MBT increased from 14.03 to 29.59 per 10,000 maternities between 2012 and 2019 (p<0.001).
- Key associated factors included amniotic fluid embolism, uterine atony, abnormal placenta, severe anemia, and advanced maternal age.
- Hysterectomy incidence decreased from 25.07% to 9.92%, and in-hospital maternal mortality ratio declined from 21.41‰ to 7.48‰ among MBT patients (p<0.001).
Conclusions:
- Obstetric MBT incidence is rising in China, necessitating targeted interventions.
- Focusing on antenatal education, evidence-based transfusion practices, and managing high-risk conditions like uterine atony and severe anemia is vital.
- Despite increasing MBT incidence, clinical outcomes have improved, indicated by reduced hysterectomy rates and maternal mortality.
Objectives:
This study aims to use the high-quality national monitoring data from the China's National Maternal Near Miss Surveillance System (NMNMSS) to ascertain the incidence, trends and risk factors of obstetric massive blood transfusion (MBT) from 2012 to 2019 in China and determine its clinical outcomes.
Settings:
Observational study of hospitalised pregnancies who had given birth or ended their pregnancy among member hospitals of NMNMSS.
Participants:
11 667 406 women were included in this study.
Primary And Secondary Outcome Measures:
We screened for the incidence, trends, risk factors and main reasons for obstetric MBT, and the outcomes after obstetric MBT. MBT was defined as the transfusion of ≥5 units of red blood cells or ≥1000 mL of whole blood. The incidence of MBT was defined as the MBT cases per 10 000 pregnancies.
Results:
Obstetric MBT occurred in 27 626 cases, corresponding to an incidence of 23.68 per 10 000 maternities, which exhibited an increasing trend in China during 2012-2019 (14.03-29.59 per 10 000 maternities, p for trend <0.001). Obstetric MBT was mainly associated with amniotic fluid embolism, uterine atony, abnormal placenta, severe anaemia, ectopic pregnancy, abortion, caesarean section, advanced maternal age and multiparous from biological effect. While from sociological effects, uterine atony, severe anaemia and placenta previa are the top three complications which more likely to undergo obstetric MBT in the Chinese population. Overall, the secular trends of hysterectomy incidence (25.07%-9.92%) and MMR during hospitalisation (21.41‰-7.48‰) among women who underwent MBT showed decreasing trends (p for trend <0.001).
Conclusion:
To minimise the incidence of obstetric MBT, more attention should be paid to education on the importance of the antenatal visit, evidence-based transfusion practice and females who are multiparous and have an advanced age, amniotic fluid embolism, uterine atony, severe anaemia and placenta previa.
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