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

Single unit transfusions in the obstetric setting: a qualitative study exploring restrictive transfusion (#23)

Eleni Mayson 1 , Jane Ford 1 , Antonia Shand 1 2
  1. Clinical and Population Perinatal Health Research Unit, The Kolling, University of Sydney, Sydney, NSW, Australia
  2. Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, NSW, Australia


The rate of obstetric blood transfusion is increasing and there is hospital variation in transfusion practice. Recent Australian guidelines recommend a restrictive transfusion strategy in maternity patients who are not actively bleeding, and advocate single unit red blood cell (RBC) transfusions followed by clinical reassessment to determine the need for further transfusion.


To identify the factors influencing single RBC unit use when initiating transfusion in a postpartum woman with non-critical bleeding.


A qualitative research study using semi-structured interviews was conducted. Nine maternity hospitals were chosen to cover a range of clinical settings (rural/ metropolitan) and obstetric transfusion rates in NSW. Interviews were conducted with the key decision-makers in the obstetric blood transfusion process: haematologists, obstetricians and midwives. Interviews were transcribed, coded, and NVivo qualitative software was used to develop themes.


125 interviews were conducted: 61 doctors’ interviews with obstetric (n=42) or haematology (n=19) training, and 64 with midwives. Obstetricians were the main transfusion decision-makers. The decision to use single unit RBC transfusions varied between and within hospitals, and did not appear to be related to a hospital’s overall obstetric transfusion rate. Most doctors (54%) interviewed would initiate transfusion with more than a single RBC unit, and of those that started with single unit transfusions, most (63%) had practised obstetrics for <5 years. Clinician and external factors influenced decision-making. Important clinician factors included perceived utility or clinical need and education/ experience. External factors included the influence of colleagues, clinical context, availability of red blood cells and blood product regulation mechanisms.


Efforts to reduce exposure to blood in the obstetric setting via the number of units transfused may need to target perceptions around the insufficiency of single units. The influence of external factors such as clinical context and blood product regulation mechanisms on single unit use warrants further investigation.