Obstetric conditions associated with the need for blood transfusion must be managed carefully in a multidisciplinary team, states the latest guidance published today by the Royal College of Obstetricians and Gynaecologists (RCOG).
The RCOG Green-top Guideline provides updated advice for healthcare professionals about the appropriate use of blood products. There are possible adverse events associated with blood transfusion which include potential infection and transmission of prions, rising costs and possible future problems with availability.
Obstetric haemorrhage remains a major cause of maternal mortality in the UK.1 It is estimated that there are more than 4,000 cases of severe haemorrhage each year in the UK; the majority of these women will need a blood transfusion.
The guideline emphasises that women at high risk of haemorrhage should be strongly advised to deliver in a hospital setting where transfusion and intensive care facilities are available, as well as access to specialist consultant care.
Additionally, all obstetric units should have a clear local protocol on how to manage major obstetric haemorrhage, which should include early involvement of a multidisciplinary team.
The guideline also provides guidance on reducing the risk of transfusion, in particular with regards to the early diagnosis of anaemia. Pregnant women should be recommended screening for anaemia at booking (ideally by 10 weeks gestation) and at 28 weeks gestation and women with multiple pregnancies should have an additional full blood count done at 20–24 weeks, highlights the guidance.
Oral iron should be the preferred first-line treatment for iron deficiency in order to reduce the risk of needing a blood transfusion in labour, notes the guidance. It is also important that women receive information about factors affecting the absorption of dietary iron and how to improve dietary iron intake.
In addition to major haemorrhage guidelines, obstetric units should have guidelines for criteria for red cell transfusion in anaemic women who are not actively bleeding. If the haemoglobin is less than 70 g/l in labour or in the immediate postpartum period, the decision to transfuse should be made according to the individual’s symptoms and medical history.
Finally, the guideline emphasises that all women should have their blood group and antibodies status checked at booking and at 28 weeks of gestation, in case they need a blood transfusion during labour.
Dr Manish Gupta, Chair of the RCOG Guideline Committee said:
“Blood transfusion may be a life-saving procedure, but it is not without risk. Rarely, recipients may develop transfusion-transmitted infection or have a negative reaction to it. The major risk, however, is of a patient receiving an incorrect blood component.
“Strict adherence to correct sampling, cross-match and administration procedures is therefore of paramount importance, even in an emergency.”
Dr. P. S. Arunakumari, the lead reviewer of the guideline, said:
“All maternity units should have a clear local protocol on how to manage major obstetric haemorrhage, which should include early involvement of a consultant obstetrician, anaesthetist, haematologist and the blood bank.
“The protocol should be updated annually and practised in ‘fire drills’ to inform and train relevant personnel.”
For further information, please contact the RCOG Media and PR team on +44 20 7772 6300 or email firstname.lastname@example.org.
The Green-top Guideline on Blood Transfusion in Obstetrics (Green-top Guideline No. 47) is available to view here.
This is the second edition of this guideline, which was first published in December 2007 and had minor amendments made to it in July 2008.