The impact of human immunodeficiency virus infection on obstetric hemorrhage and blood transfusion in South Africa

Evan Bloch, Robert L. Crookes, Jennifer Hull, Sue Fawcus, Rajesh Gangaram, John Anthony, Charlotte Ingram, Solomuzi Ngcobo, Julie Croxford, Darryl V. Creel, Edward L. Murphy

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1675-1684
Number of pages10
JournalTransfusion
Volume55
Issue number7
DOIs
StatePublished - Jul 1 2015
Externally publishedYes

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Virus Diseases
South Africa
Blood Transfusion
Obstetrics
HIV
Hemorrhage
Peripartum Period
Incidence
Odds Ratio
Confidence Intervals
Prenatal Care
Maternal Mortality
Gestational Age
Anemia
Hemoglobins
Cross-Sectional Studies
Logistic Models
Morbidity

ASJC Scopus subject areas

  • Hematology
  • Immunology
  • Immunology and Allergy
  • Medicine(all)

Cite this

Bloch, E., Crookes, R. L., Hull, J., Fawcus, S., Gangaram, R., Anthony, J., ... Murphy, E. L. (2015). The impact of human immunodeficiency virus infection on obstetric hemorrhage and blood transfusion in South Africa. Transfusion, 55(7), 1675-1684. https://doi.org/10.1111/trf.13040

The impact of human immunodeficiency virus infection on obstetric hemorrhage and blood transfusion in South Africa. / Bloch, Evan; Crookes, Robert L.; Hull, Jennifer; Fawcus, Sue; Gangaram, Rajesh; Anthony, John; Ingram, Charlotte; Ngcobo, Solomuzi; Croxford, Julie; Creel, Darryl V.; Murphy, Edward L.

In: Transfusion, Vol. 55, No. 7, 01.07.2015, p. 1675-1684.

Research output: Contribution to journalArticle

Bloch, E, Crookes, RL, Hull, J, Fawcus, S, Gangaram, R, Anthony, J, Ingram, C, Ngcobo, S, Croxford, J, Creel, DV & Murphy, EL 2015, 'The impact of human immunodeficiency virus infection on obstetric hemorrhage and blood transfusion in South Africa', Transfusion, vol. 55, no. 7, pp. 1675-1684. https://doi.org/10.1111/trf.13040
Bloch, Evan ; Crookes, Robert L. ; Hull, Jennifer ; Fawcus, Sue ; Gangaram, Rajesh ; Anthony, John ; Ingram, Charlotte ; Ngcobo, Solomuzi ; Croxford, Julie ; Creel, Darryl V. ; Murphy, Edward L. / The impact of human immunodeficiency virus infection on obstetric hemorrhage and blood transfusion in South Africa. In: Transfusion. 2015 ; Vol. 55, No. 7. pp. 1675-1684.
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abstract = "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.",
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T1 - The impact of human immunodeficiency virus infection on obstetric hemorrhage and blood transfusion in South Africa

AU - Bloch, Evan

AU - Crookes, Robert L.

AU - Hull, Jennifer

AU - Fawcus, Sue

AU - Gangaram, Rajesh

AU - Anthony, John

AU - Ingram, Charlotte

AU - Ngcobo, Solomuzi

AU - Croxford, Julie

AU - Creel, Darryl V.

AU - Murphy, Edward L.

PY - 2015/7/1

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N2 - 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.

AB - 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.

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