Prevalence and Indications of Blood And Blood Component Transfusion Among Obstetric Patients in A Tertiary Care Hospital: A Cross-Sectional Study

Abstract

Background: Blood transfusion is a critical component of obstetric care, particularly in the management of postpartum haemorrhage (PPH), anaemia, and other causes of significant maternal blood loss. Despite advances in obstetric care, the requirement for blood and blood components remains an important indicator of severe obstetric morbidity. Identification of clinical factors associated with increased transfusion requirements may facilitate early risk stratification and improve transfusion preparedness.

Objective: To determine the indications and patterns of blood and blood component transfusion among obstetric patients and to identify factors independently associated with massive transfusion in a tertiary care hospital.

Methods: This hospital-based cross-sectional observational study was conducted in the Department of Obstetrics and Gynaecology at Sree Balaji Medical College and Hospital, Chennai, over a period of six months from September 2025 to February 2026. A total of 120 obstetric patients who received blood or blood component transfusion during hospital admission were included using consecutive sampling. Demographic characteristics, obstetric profile, indications for transfusion, blood component utilization, clinical characteristics, and maternal and neonatal outcomes were recorded using a structured proforma. Written informed consent was obtained from all participants before enrolment, and confidentiality of patient information was maintained. Data were analysed using IBM SPSS version 26. Categorical variables were analysed using the chi-square test or Fisher's exact test, while appropriate tests were used for continuous variables. Multivariate logistic regression was performed to identify independent predictors of massive transfusion, defined as administration of ≥4 units of PRBCs. A p-value <0.05 was considered statistically significant.

Results: The majority of patients were aged 21–30 years (65.0%) and were multigravida (56.7%). Antenatal anaemia was present in 85.0% of patients, with 75.0% having mild-to-moderate anaemia and 10.0% having severe anaemia. Postpartum haemorrhage was the most common indication for transfusion (37.5%), followed by postpartum anaemia (16.7%) and antenatal anaemia (16.7%). Antepartum haemorrhage accounted for 4.2% of transfusion indications. Packed red blood cells were administered to all patients (100%), while fresh frozen plasma was administered to 51.7%, platelets to 23.3%, cryoprecipitate to 10.0%, and whole blood to 15.0%. Massive transfusion was required in 20.0% of patients. On multivariate analysis, obesity (AOR 4.12, 95% CI: 1.24–13.74; p=0.021), severe antenatal anaemia (AOR 4.22, 95% CI: 1.10–16.10; p=0.036), PPH (AOR 3.89, 95% CI: 1.42–10.60; p=0.008), and hypertension (AOR 2.76, 95% CI: 1.01–7.52; p=0.047) were identified as independent predictors of massive transfusion.

Conclusion: Postpartum haemorrhage and anaemia were the predominant indications for blood and blood component transfusion among obstetric patients. The substantial requirement for multiple blood components and massive transfusion reflects the severity of obstetric complications encountered in this population. Obesity, severe antenatal anaemia, PPH, and hypertension were independent predictors of massive transfusion, highlighting the importance of early risk identification and preparedness for major obstetric haemorrhage. Strengthening antenatal anaemia screening and treatment, timely recognition and management of PPH, and implementation of standardized patient standardized transfusion practices strategies may help optimize transfusion practices and improve maternal outcomes.