Blood transfusion practices in obstetric care at a tertiary referral hospital in Zimbabwe

Background: Blood transfusions are an essential element of obstetric care and may have a role in reducing maternal mortality, if used appropriately. Monitoring of transfusion practices provides information on current and future needs of blood. It may also lead to rational use of blood transfusions. Identifying common obstetric complications requiring transfusions is also critical for informing the development of appropriate operational maternal health programmes necessary for preventing their recurrence. Aim: To describe the demographic characteristics of blood transfusion recipients, and diagnoses associated with the use of blood and blood components in obstetric care in Zimbabwe. Study design and methods: Data on the characteristics of the blood transfusion recipients (age, sex, blood group), blood components received (type, quantity), discharge diagnoses and outcomes following transfusion (discharge status, length of stay in hospital), were retrospectively collected from Mbuya Nehanda Maternity Hospital, a tertiary referral hospital, during the period January 1, 2014 through December 31, 2014. Diagnoses were grouped into categories according to the block codes under Chapter 15 of the International Classification of Diseases, (ICD-10). Results: The total number of admissions in the maternity wards of the hospital was 12450. Of these, 416 (3.3%) received blood transfusion as part of obstetric care. The median age of the recipients was 30 years (range; 15 - 55 years). Most of the recipients (n = 301; 84.3%) were in the age group 20-39 years. The majority of these recipients (n = 412; 99.0%) received a red blood cell transfusion. The median number of red blood cell units transfused per recipient was 2 units (range; 1-11 units). The majority of the transfusion recipients were diagnosed with complications of labour and delivery (n = 147; 35.3%), and pregnancy with abortive outcome (n = 141; 33.9%). The majority of the recipients required blood for the management of postpartum haemorrhage (130; 31.3%). The median length of stay in hospital was 4 days (range, 1-59) and in-hospital mortality was 4.0%. [TABLE PRESENTED] Conclusions: The rate of blood transfusion is comparable to rates reported elsewhere in sub-Saharan Africa. With most of the patients requiring blood for postpartum haemorrhage, further research is required to identify factors associated with excessive blood loss and the need for transfusions. The treatment of underlying anaemia, as a preventative measure, may also aid in reducing postpartum haemorrhage