Blood product use for hemorrhage during cesarean delivery

Authors

• Luis Pacheco, University of Texas Medical Branch, Obstetrics & Gynecology, Texas, United States, Galveston.
• Steve Weiner, The George Washington University, Biostatistics Center, Maryland, United States, Rockville.
• George Saade, EVMS, OB-GYN, Virginia, United States, Norfolk.
• Rebecca Clifton, George Washington University, Biostatistics Center, Maryland, United States, Rockville.
• Samuel Parry, University of Pennsylvania Perelman School of Medicine, Obstetrics and Gynecology, Pennsylvania, United States, Philadelphia.
• John M. Thorp
• Monica Longo
• Ashley Salazar
• Alan Tita, University of Alabama at Birmingham, Obstetrics and Gynecology, Alabama, United States, Birmingham.
• Cynthia Gyamfi-Bannerman, University of California San Diego, California, United States, La Jolla.
• Suneet P. Chauhan, Delaware Center of Maternal-Fetal Medicine, Maternal-Fetal Medicine, Delaware, United States, Newark.
• Torri Metz, University of Utah Health Sciences Center, Utah, United States, Salt Lake City.
• Kara Rood, Ohio State Wexner Medical Center, MFM, Ohio, United States, Columbus.
• Dwight J. Rouse, Brown University, Rhode Island, United States, Providence.
• Jennifer Bailit, MetroHealth Medical Center, Ohio, United States, Cleveland.
• William A. Grobman, Brown University, Rhode Island, United States, Providence.
• Hyagriv Simhan, University of Pittsburgh School of Medicine, Ob/Gyn, Pennsylvania, United States, Pittsburgh.
• George Macones, University of Texas at Austin Dell Medical School, Department of Women's Health, Texas, United States, Austin.

Document Type

Journal Article

Publication Date

4-23-2026

Journal

American journal of perinatology

DOI

10.1055/a-2859-5641

Abstract

BACKGROUND: Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality. Little is known about transfusion practices in patients requiring blood tansfusions following cesarean delivery. OBJECTIVE: To describe the use of blood products, clotting factors, colloids, and antifibrinolytics in a contemporary cohort of patients with hemorrhage during cesarean and compare blood product use with a historic cohort of patients with a similar diagnosis. STUDY DESIGN: Secondary analysis of a multicenter trial of tranexamic acid (TXA) vs placebo to prevent postpartum hemorrhage during cesarean delivery. Patients with qualitative estimated intraoperative blood loss (EBL) of more than 1 liter were included in this analysis. Variables analyzed included transfusion of blood products, ratio of transfused PRBC to fresh frozen plasma (FFP) and platelets, and use of clotting factors, anti-fibrinolytics, and colloids. Transfusion strategies were also compared with a historic cohort from the APEX study. RESULTS: Of the 707 (7.7%) who had EBL of greater than 1 liter, packed red cells were transfused in 21.1%, fresh frozen plasma in 5.4%, platelets in 2.4%, and cryoprecipitate in 2.3%. Among patients who received both PRBC and FFP, three quarters had a PRBC:FFP ratio between 1:1 and 2:1. Patients receiving both PRBC and platelets had a 1:1 ratio or less in 76.5% of cases. Clotting factor concentrates were not used in any case. Albumin was administered in 10.2% of cases. When compared with the historic cohort with an EBL >1 liter during cesarean, no differences in the use of blood products was noted. CONCLUSIONS: 1 in 5 patients with intraoperative EBL > 1 liter received PRBC transfusion. The use of other blood products was rare. There was no difference in transfusion strategies overtime when compared with a similar historic cohort. Obstetrical hemorrhage in patients undergoing cesarean delivery rarely involves intensive transfusion therapy.

APA Citation

Pacheco, Luis; Weiner, Steve; Saade, George; Clifton, Rebecca; Parry, Samuel; Thorp, John M.; Longo, Monica; Salazar, Ashley; Tita, Alan; Gyamfi-Bannerman, Cynthia; Chauhan, Suneet P.; Metz, Torri; Rood, Kara; Rouse, Dwight J.; Bailit, Jennifer; Grobman, William A.; Simhan, Hyagriv; and Macones, George, "Blood product use for hemorrhage during cesarean delivery" (2026). GW Authored Works. Paper 9023.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/9023

Department

Epidemiology