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October 21, 2019
10/21/2019 9:30:00 AM - 10/21/2019 11:30:00 AM
Room WA2 - Area D
Anemia at Admission for Labor and Delivery and the Risk of Transfusion after Vaginal Delivery
Ghislaine Echevarria, M.D., Chritina Dgheim, D.O., Carolyn C. Junior, M.D., Gilbert J. Grant, M.D.
New York University, New York, NY, USA, NEW YORK, New York , United States
Disclosures: G. Echevarria: None.C. Dgheim: None.C.C. Junior: None.G.J. Grant: None.
Pre-delivery anemia is associated with a greater incidence of transfusion[1], preterm delivery and low birth weight[2]. Anemia may be worsened by hemorrhage that accompanies delivery, increasing the risk of depression, fatigue and impaired cognition, and negatively affecting mother-baby bonding[3]. The aim of this study was to examine the effect of maternal anemia during the third trimester of pregnancy, defined as hemoglobin (Hb) less than 11 g/dl [4], on postpartum hemorrhage, transfusion requirements and length of hospital stay (LOS). Methods: Data extracted from the electronic health records of our institution were merged with the prospective clinical registry maintained by the labor and delivery service. All vaginal delivery patients with a gestational age of 28 weeks or greater from January 1, 2014 to June 30, 2018 were included (n=18,753). For each encounter we extracted demographic data, laboratory results on admission, obstetrical data (use of oxytocin either for induction and/or augmentation of labor, vacuum and forceps-assisted delivery, vaginal birth after cesarean, birth weight, gestational age, multiple gestation, and parity), quantified of blood loss (QBL) at delivery, RBC transfusion, and LOS. Stepwise multiple linear and logistic regression were used to assess the association between the presence of anemia on admission and the need for transfusion of RBCs, QBL and LOS, adjusted for potential confounding factors based on previous studies and those with a p-value of <0.25 in the univariable analysis. Results: The incidence of anemia in our population was 5.7% (1,059 patients). In the adjusted logistic regression model, the odds of receiving an RBC transfusion among anemic patients on admission was 5.4 (95% CI: 3.6-8.2) times greater than the odds of transfusion among patients without anemia. Based on the adjusted analysis of QBL, anemic patients bled 26.2 mL more than those without anemia (b coefficient 95%CI, 8.8-43.7, p=0.003). We also found a statistically but not clinically significant difference between LOS in the anemic vs non anemic patients (median 2.4 (IQR:2-2.7) days and 2.3 (IQR:2-2.6) days, respectively (p<0.001)). Discussion: Anemia present at the time of admission, used as proxy for anemia during the third trimester of pregnancy, was associated with an increased likelihood of transfusion in the immediate post-delivery period. We also found statistically but not clinically significant differences in QBL and LOS between cohorts. As transfusion is not without risk, it is desirable to decrease the need for transfusion by properly identifying the underlying etiology of anemia and instituting appropriate treatment during pregnancy. Iron deficiency is the most common cause of anemia in pregnancy, and iron supplementation is a time-honored means of treating anemia. It has few adverse effects and is fairly well tolerated. In several studies involving micronutrient supplementation, i.e., p.o. iron and folate, the consequences of anemia in pregnant women have been mitigated[5]. Furthermore, i.v. compared to p.o. iron repletion in pregnancy has been associated with a lower RBC transfusion rate[6] and a greater increase in postpartum Hb[7]. Identification and treatment of antepartum anemia may help reduce the prevalence and/or severity of postpartum anemia[3]. By identifying patients with anemia, and implementing effective therapy prior to delivery, we may be able to lower patient risks, improve patient outcomes and achieve cost savings for healthcare systems. References: 1. Drukker L, et al. Transfusion. 2015 Dec;55(12):2799-806. 2. MMWR Recomm Rep.1998;47(RR-3):1-29. 3. Butwick AJ et al. Transfusion. 2017 Jan;57(1):36-44. 4. ACOG practice bulletin No. 95. Obstet Gynecol 2008;112:201-7. 5. Keats EC, et al. Cochrane Database Syst Rev. 2019 Mar 14;3:CD004905 6. Ellermann, I., et al. Anesth Analg. 2018 Nov;127(5):1202-1210. 7. Sultan, P et al.. Am J Obstet Gynecol. 2018 Dec 19. pii: S0002-9378(18)32226-9.

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