Decision to blood transfusion time, outcomes and associated factors in obstetric patients at Kawempe National Referral Hospital, Uganda

Abstract

Background Blood transfusion (BT) is an essential component of Comprehensive Emergency Obstetric and Neonatal Care (CEmONC). BT is key in managing complicated obstetric haemorrhage, a leading cause of maternal mortality and morbidity worldwide; obstetric haemorrhage accounts for 42% of maternal deaths in Uganda. Safe and timely blood transfusion contributes to the reduction of maternal mortality. Though BT is a common practice there is a paucity of data on practices in obstetrics and gynaecology and on the timeliness of blood transfusion. Objective To evaluate the decision to transfusion time in obstetric patients requiring blood transfusion, the patient outcomes, and associated factors. Method This was a cross-sectional study that was conducted at Kawempe National Referral Hospital (KNRH). Two hundred and sixty-nine (269) women were enrolled in this study and data was collected between August 2022 and November 2022. Study participants included all pregnant women and women within 42 days of pregnancy termination, requiring a blood transfusion. Participants were recruited following a blood transfusion. Data was collected using an interviewer-administered questionnaire, entered using the Epi-data software version classic 4.4.6 and analysed using the statistical software STATA version 14. Results The median decision to transfusion time was 2.42 hours (1.17-5.96), the longest time a participant had to wait for a transfusion was 111.2 hours (4.63 days) and the shortest was 13 minutes. The median decision-to-transfusion time for intraoperative transfusions was 45 minutes. The most common indication for transfusion in this study was PPH due to uterine atony (15%) followed by APH due to placenta previa (11.52%) and abruptio (11.15%), respectively. The decision to transfuse was made mainly by an SHO (69.14%) followed by a JHO (14.87%). The Factors that were found to be associated with a decision to transfusion time of an hour or less were diagnosis of placenta previa, uterine rupture, haemorrhage at caesarean section and readily available blood in the laboratory. Factors associated with delayed blood transfusion were lack of blood or specific blood group. The overall percentage of adverse reactions was 1.86% and one maternal death due to brainstem death unrelated to delays in blood transfusion or adverse reaction. The median duration of hospital stay was four days in this study. Conclusion The findings of this study indicate that the decision to transfusion time is longer compared to other institutions where their benchmark for turnaround time is set at 30 minutes. The factors that were significantly associated with a decision to transfusion time of less than an hour were placenta previa, uterine rupture and haemorrhage at CS. Delays in blood transfusion were associated with a lack of blood or its products in the laboratory, a larger study needs to be done to explore this factor.