Patient blood management in obstetrics and gynecology: current evidence and future directions

Anemia and obstetric hemorrhage remain major causes of maternal morbidity, transfusion exposure, and resource use. Patient Blood Management (PBM) provides a structured, patient-centered framework for optimizing red cell mass, minimizing blood loss, and applying evidence-based transfusion practice in obstetrics and gynecology.

A structured narrative review was conducted using PubMed/MEDLINE, Cochrane Library, and Scopus for English-language literature published from January 2015 to February 2026, prioritizing randomized trials, systematic reviews, consensus statements, guidelines, implementation studies, and large observational cohorts relevant to PBM in women's health.

Current evidence supports antenatal and preoperative identification of iron deficiency, timely oral or intravenous iron therapy, early postpartum hemorrhage recognition, tranexamic acid, targeted cell salvage, viscoelastic hemostatic testing, and restrictive single-unit transfusion strategies. PBM programs have reduced blood product use in major obstetric hemorrhage from 4.18 to 0.67 units per admission and predelivery anemia from 40.3 % to 23.8 %. Population data show that transfused delivering women have high anemia and postpartum hemorrhage prevalence, while severe antenatal anemia markedly increases death or maternal near-miss risk. In gynecologic oncology, structured PBM bundles and education programs substantially reduce perioperative transfusion rates.

PBM offers a structured, evidence-informed framework for obstetric and gynecologic care. Several individual components are supported by randomized trial data, whereas evidence for comprehensive PBM programs remains predominantly observational. Effective implementation requires multidisciplinary protocols, early anemia treatment, blood-conservation strategies, and disciplined transfusion thresholds, while future work should standardize implementation and measure patient-centered outcomes.