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Blood Product Use for Hemorrhage during Cesarean Delivery
Luis Pacheco1, Steve Weiner2, George Saade1
1Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, United States.
American Journal of Perinatology
|April 23, 2026
Summary
Postpartum hemorrhage during cesarean delivery rarely requires intensive transfusion therapy. One in five patients with significant blood loss received red blood cells, with rare use of other blood products.
Area of Science:
- Obstetrics and Gynecology
- Anesthesiology
- Transfusion Medicine
Background:
- Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality.
- Transfusion practices in cesarean delivery patients with PPH are not well understood.
Purpose of the Study:
- To describe blood product, clotting factor, colloid, and antifibrinolytic use in contemporary cesarean delivery patients with hemorrhage.
- To compare these practices with a historic cohort.
Main Methods:
- Secondary analysis of a tranexamic acid (TXA) vs. placebo trial.
- Included patients with estimated intraoperative blood loss (EBL) > 1 liter.
- Compared transfusion strategies with the historic APEX study cohort.
Main Results:
- 21.1% of patients with EBL > 1 liter received packed red blood cells (PRBCs).
- Fresh frozen plasma (5.4%), platelets (2.4%), and cryoprecipitate (2.3%) use was infrequent.
- Albumin was used in 10.2%; clotting factors were not used.
- No difference in transfusion practices compared to the historic cohort.
Conclusions:
- Intraoperative EBL > 1 liter during cesarean delivery leads to PRBC transfusion in 1 in 5 patients.
- Use of other blood products is uncommon.
- Transfusion strategies have remained consistent over time.
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