Patient Blood Management in Obstetrics

Obstetric anemia and hemorrhage are major causes of maternal morbidity and increased healthcare utilization. Although red blood cell (RBC) transfusion is commonly used, it is associated with higher rates of postpartum complications, including pneumonia, renal failure, and cardiac events (Kloka et al.). Patient Blood Management (PBM) is an evidence-based approach that aims to optimize a patient's own blood and reduce avoidable transfusion through three pillars: treating anemia and iron deficiency, minimizing blood loss, and avoiding unnecessary transfusion. International guidelines support PBM in obstetrics, but data on comprehensive program implementation remain limited due to barriers such as resource constraints and the need for multidisciplinary coordination. Aims , objectives and Hypotheses Primary Aim To assess the association between PBM implementation and blood product utilisation among all obstetric deliveries at Corniche Hospital between 2018 and 2025. Primary Objective To estimate the change over time in the mean number of blood product units transfused per delivery (combined and by product type). Primary Hypothesis Increasing PBM maturity over time, particularly following comprehensive PBM implementation in 2022, is associated with a significant reduction in mean blood product units transfused per delivery, after adjusting for changes in case-mix. Secondary Objectives Secondary objectives include evaluating changes in transfusion-related practice and anemia outcomes, including proportion of deliveries receiving any transfusion; pretransfusion hemoglobin thresholds in non-actively bleeding patients (where definable); predelivery anemia prevalence (and iron therapy utilization where captured). Maternal outcomes will be evaluated by reporting composite morbidity; postpartum hysterectomy; hospital length of stay; High Dependency unit (HDU)/ICU admission and length of stay; 28-day all-cause emergency readmissions; in-hospital mortality. Neonatal outcomes will not be included. At Corniche Hospital, prior evaluation in cases of major obstetric hemorrhage showed that PBM reduced blood product use and improved hemoglobin recovery without increasing morbidity (Ansari et al.). This study extends the assessment to all deliveries from 2018-2025 to evaluate hospital-wide changes in transfusion practice and maternal outcomes as PBM implementation matured.

Aims / Objectives / Hypotheses Primary Aim To assess the association between PBM implementation and blood product utilization among all obstetric deliveries at Corniche Hospital between 2018 and 2025. Primary Objective To estimate the change over time in the mean number of blood product units transfused per delivery (combined and by product type). Primary Hypothesis Increasing PBM maturity over time, particularly following comprehensive PBM implementation in 2022, is associated with a significant reduction in mean blood product units transfused per delivery, after adjusting for changes in case-mix. Secondary Objectives Secondary objectives include evaluating changes in transfusion-related practice and anemia outcomes, including proportion of deliveries receiving any transfusion; pretransfusion hemoglobin thresholds in non-actively bleeding patients (where definable); predelivery anemia prevalence (and iron therapy utilization where captured). Maternal outcomes will be evaluated by reporting composite morbidity; postpartum hysterectomy; hospital length of stay; HDU/ICU admission and length of stay; 28-day all-cause emergency readmissions; in-hospital mortality. Neonatal outcomes will not be included. Study Type Retrospective observational cohort study. Setting Corniche Hospital is a 180-bed tertiary obstetric referral center in the Emirate of Abu Dhabi, United Arab Emirates, with a 64-cot level III neonatal intensive care unit. Over the past 8 years, it has averaged approximately 5500 deliveries annually, with an average cesarean delivery rate of 35%. PBM strategies were implemented progressively, with a comprehensive PBM program established in 2022, supported by governance structures (PBM committee), information systems (dashboards/decision support), education, and updated policies. Study Period 1 January 2018 to 31 December 2025. Participants Inclusion Criteria All women who delivered at Corniche Hospital during the study period (vaginal, operative vaginal, caesarean; livebirth or stillbirth depending on local definition). Exclusion Criteria : None PBM Program Description (Exposure) The main exposure of interest is the implementation of a comprehensive PBM program in 2022. While some PBM strategies were in place in 2018, the comprehensive PBM program at Corniche Hospital was established in 2022 with the formation of a PBM committee led by a consultant anesthetist serving as the program coordinator (Principal Investigator T.A.), and representatives from most clinical and nonclinical departments. PBM strategies at Corniche Hospital comprise clinical and enabling interventions across three pillars. The program is implemented at scale hospital-wide, with key strategies described in the prior major haemorrhage evaluation and the earlier protocol framework. Data Collection For each study participant we have the following data: patient age, body mass index (BMI), parity, gestational age at delivery, mode of delivery, comorbidities (eg. place trial.show_full_description

Inclusion Criteria: * All women delivered at Corniche Hospital during the study period Exclusion Criteria: * None