Poster Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2015

Factors influencing blood transfusion practice in obstetrics (#105)

Eleni Mayson 1 , Jane Ford 2
  1. Clinical and Population Perinatal Health Research Unit, The Kolling, University of Sydney, Sydney, NSW, Australia
  2. Clinical and Population Perinatal Health Research Unit, The Kolling, University of Sydney, Sydney, NSW, Australia


Obstetric transfusion rates are increasing in Australia and world-wide, and variation in transfusion practice exists. In an era of patient blood management where it is recognised that blood is a precious resource that carries risks, and that liberal transfusion is associated with adverse patient outcomes, we undertook a qualitative study to identify the factors influencing obstetric transfusion practice.


To identify the factors influencing obstetric blood transfusion practice at maternity hospitals in NSW with a range of geographical locations, clinical settings and obstetric transfusion rates.


A qualitative research study using semi-structured interviews was conducted. Nine maternity units were chosen to cover a range of clinical settings (rural/ metropolitan) and obstetric transfusion rates. Interviews were conducted in person with the key decision-makers in the maternity blood transfusion process: haematologists, obstetricians, midwives, midwifery unit managers and clinical midwifery educators. Interviews were transcribed, hospital characteristics were tabulated and open-ended questions coded. NVivo qualitative software was used to identify themes.


125 interviews were conducted: 61 with doctors who had obstetric (n=42) or haematology (n=19) training, and 64 with midwives. Obstetricians were the main transfusion decision-makers. High transfusing hospitals were more likely to be rural or geographically isolated, to treat lower obstetric risk women, have smaller staff numbers with less varied skill-mix and less access to specialist services, have smaller blood inventories and delays in accessing blood outside that available inventory, and have less stringent blood product regulation mechanisms.


Hospital, clinician and patient-level factors influenced blood transfusion practices. Clinical context, resource availability, clinician knowledge/experience and the perceived utility of specific interventions were among the factors influencing transfusion practice. These findings have implications for clinician education, blood product provision and inventory management.