The impact of human immunodeficiency virus infection on obstetric hemorrhage and blood transfusion in South Africa
Blood Systems Research Institute, 270 Masonic Avenue, San Francisco, CA, United States; University of California at San Francisco, San Francisco, CA, United States; South African National Blood Service, Weltevreden Park, South Africa; Chris-Hani Baragwanath Hospital, Johannesburg, South Africa; University of Witwatersrand, Johannesburg, South Africa; Mowbray Maternity Hospital, Cape Town, South Africa; University of Cape Town, Cape Town, South Africa; King Edward VIII Hospital, Durban, South Africa; University of Kwazulu-Natal, Durban, South Africa; Groote Schuur Hospital, Cape Town, South Africa; RTI International, Research Triangle Park, NC, United States
BACKGROUND Globally, as in South Africa, obstetric hemorrhage (OH) remains a leading cause of maternal mortality and morbidity. Although blood transfusion is critical to OH management, the incidence and predictors of transfusion as well as their relation to human immunodeficiency virus (HIV) infection are poorly described. STUDY DESIGN AND METHODS A cross-sectional study was conducted of all peripartum patients at four major hospitals in South Africa (April to July 2012). Comprehensive clinical data were collected on patients who sustained OH and/or were transfused. Logistic regression was used to model risk factors for OH and transfusion. RESULTS A total of 15,725 peripartum women were evaluated, of whom 3969 (25.2%) were HIV positive. Overall, 387 (2.5%) women sustained OH and 438 (2.8%) received transfusions, including 213 (1.4%) women with both OH and transfusion. There was no significant difference in OH incidence between HIV-positive (2.8%) and HIV-negative (2.3%) patients (adjusted odds ratio [OR], 0.95; 95% confidence interval [CI], 0.72-1.25). In contrast, the incidence of blood transfusion was significantly higher in HIV-positive (3.7%) than in HIV-negative (2.4%) patients (adjusted OR, 1.52; 95% CI, 1.14-2.03). Other risk factors for transfusion included OH, low prenatal hemoglobin, the treating hospital, lack of prenatal care, and gestational age of not more than 34 weeks. CONCLUSION In the South African obstetric setting, the incidence of peripartum blood transfusion is significantly higher than in the United States and other high-income countries while OH incidence is similar. While OH and prenatal anemia are major predictors of transfusion, HIV infection is a common and independent contributing factor. © 2015 AABB.
hemoglobin; adult; Article; blood transfusion; cesarean section; cross-sectional study; female; gestational age; human; Human immunodeficiency virus infection; Human immunodeficiency virus prevalence; major clinical study; obstetric hemorrhage; perinatal period; practice guideline; prenatal care; risk factor; South Africa; vaginal delivery; adolescent; blood; clinical trial; HIV Infections; incidence; multicenter study; postpartum hemorrhage; pregnancy; virology; Adolescent; Adult; Blood Transfusion; Cross-Sectional Studies; Female; HIV Infections; Humans; Incidence; Postpartum Hemorrhage; Pregnancy; Risk Factors; South Africa