Blood transfusion in the context of maternity care
This article highlights principles for the safe administration of blood transfusion in maternity care. The aim is to increase awareness of the context for blood transfusion in midwifery, the components most frequently used and the process for safe blood transfusion, including clinical observations. There are serious hazards associated with this procedure so there should be a clear indication for transfusion. Midwives must not engage in the administration of blood unless they have received appropriate training, have been assessed as clinically competent and meet the requirements for periodic review or assessment in administering blood transfusion.
In contemporary midwifery practice, the administration of blood transfusion (BT) has been relatively rare, compounded by the scarcity of blood, with an approximate incidence of 6% of BT in maternity care (Serious Hazards of Transfusion (SHOT), 2015a). Major obstetric haemorrhage is a cause of death in the UK (Cantwell et al, 2011; Knight et al, 2014); it is associated with medical complications (Kayem et al, 2011), recurrent operative delivery, and exponential risk of placental abnormalities (NHS Litigation Authority, 2010). The involvement of midwives in efficiently rehearsed multidisciplinary drills, including rapid access to emergency group O-negative blood and effective communication with the transfusion laboratory, will help to minimise maternal complications. Accurate assessment of blood loss is complex; therefore, appropriate use of BT can minimise mortality and morbidity. A haemoglobin level of Hb < 70 g/l in labour may precipitate BT (Royal College of Obstetricians and Gynaecologists (RCOG), 2015), hence it is clear that midwives must be competent in the administration of BT.
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