Background
Intravenous (IV) iron is an effective treatment of pregnancy-related iron deficiency anaemia (IDA) and may have a role in reducing blood transfusions. Recently released obstetric transfusion guidelines recommend IV iron in maternity patients requiring iron when oral formulations are poorly tolerated, unlikely to be well absorbed, or when rapid restoration of iron stores is required.
Aim
To identify barriers and facilitators to the use of IV iron in pregnancy amongst nine maternity hospitals in NSW.
Method
A qualitative research study was undertaken using semi-structured interviews. Nine maternity units were chosen to cover a range of clinical settings (rural/ metropolitan) and obstetric blood transfusion rates. Interviews were conducted with haematologists, obstetricians and midwives, and included questions about the use of IV iron in each institution. Interviews were transcribed, coded, and NVivo qualitative software was used to develop themes.
Results
125 interviews were conducted: 61 with doctors who had obstetric (n=42) or haematology (n=19) training, and 64 with midwives. The use of IV iron differed between hospitals and doctors. There were hospital/pharmaceutical, clinician and patient factors which acted as either barriers or facilitators to its use. Where perceived barriers outweighed facilitators in a particular hospital, doctors were less likely to use IV iron.
Conclusion
The use of IV iron, as perceived by doctors, differed across hospitals regardless of the obstetric blood transfusion rate. There are some potentially modifiable barriers to its use such as optimising the logistics of IV iron administration, and education on appropriate use reinforced by local champions. These factors may need to be addressed for IV iron to be available to obstetric patients not tolerating oral formulations or requiring rapid restoration of iron stores.