Oral Concurrent Session 1 - Medical and Surgical Complications of Pregnancy
Oral Concurrent Sessions
Ellen H. Crowe, BS, MD
Resident
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Ahmed Zaki Moustafa, MD, MS (he/him/his)
Assistant Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
University of Texas - Houston, Texas, United States
.jpg "Megan C. Shepherd, MD (she/her/hers) photo")
Megan C. Shepherd, MD (she/her/hers)
Assistant Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Baha M. Sibai, MD
Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Sean C. Blackwell, MBA, MD
Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Aaron W. Roberts, MD
Assistant Professor, Maternal Fetal Medicine
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Common practice to determine patients’ response to uncomplicated blood transfusion is to assess hemoglobin concentration 4 hours post-transfusion. The need for this practice has been disproven in non-obstetric surgical patients, and patients with gastrointestinal bleeding. Given known fluid shifts that occur post-delivery, it is still unknown whether postpartum patients require time to “equilibrate” to the true steady state hemoglobin value after completing transfusion. Our goal is to determine if waiting 4 hours following transfusion to reassess the hemoglobin level is necessary. If hemoglobin concentration equilibration occurs immediately post-transfusion, delays in reassessment and management of postpartum anemia could be avoided.
Study Design:
This is a prospective study in which serial hemoglobin assessments were completed following the transfusion of packed red blood cells (PRBCs) (immediate, 4 hours, 12 hours after transfusion). Patients were excluded if there was suspicion for ongoing bleeding, hemodynamic instability, planned return to the operating room, >72 hours from delivery, or if a collection timing was missed within 15 minutes of the protocol. Power analysis determined 23 patients would be needed for 80% power to detect a difference of 0.6g/dL using paired t-tests with a p value of < 0.05.
Results:
From February 2025-July 2025, a total of 38 patients were identified that received PRBC transfusion due to acute blood loss at delivery. 25 met criteria and completed the study protocol. There was no difference between mean hemoglobin concentration in g/dL between the immediate (0.16 g/dL, 95% CI -0.41 – 0.26) and 4-hour post transfusion (0.14 g/dL, 95% CI -0.38 – 0.21) hemoglobin when compared to 12-hour post transfusion hemoglobin (Figure 1). An arbitrary 4-hour delay between completion of blood transfusion and laboratory testing is not required for assessment in postpartum patients to determine steady state hemoglobin level. Earlier evaluation of hemoglobin following transfusion could more quickly determine the need for additional interventions or transfusion.
Conclusion: