Arriaga AF, Bader AM, Wong JM, Lipsitz SR, Berry WR, Ziewacz JE, Hepner DL, Boorman DJ, Pozner CN, Smink DS, Gawande AA Simulation-based trial of surgical-crisis checklists. N Engl J Med. 2013; 368:(3)246-53

London: Department of Health; 2011

British Committee for Standards in Haemotology. 2012. (accessed 14 November 2016)

British Committee for Standards in Haemotology. 2014. (accessed 1 November 2016)

Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, Harper A, Hulbert D, Lucas S, McClure J, Millward-Sadler H, Neilson J, Nelson-Piercy C, Norman J, O'Herlihy C, Oates M, Shakespeare J, de Swiet M, Williamson C, Beale V, Knight M, Lennox C, Miller A, Parmar D, Rogers J, Springett A Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG. 2011; 118:1-203

Department of Health. Health Service Circular: Better Blood Transfusion. HSC 1988/224. 1998. (accessed 1 November 2016)

Department of Health. Health Service Circular: Better Blood Transfusion – appropriate use of blood. HSC 2002/009. 2002. (accessed 1 November 2016)

Department of Health. Health Service Circular: Better Blood Transfusion – safe and appropriate use of blood. HSC 2007/001. 2007. (accessed 1 November 2016)

London: DH; 2012

Health Education England. 2016. (accessed 1 November 2016)

HM Government. The Blood Safety and Quality (Amendment) (No.2) Regulations 2005. 2005. (accessed 1 November 2016)

International Haemovigilance Network, International Society for Blood Transfusion. Proposed standard definitions for surveillance of non-infectious adverse transfusion reactions. 2011. (accessed 1 November 2016)

International Haemovigliance Network. Definition of haemovigilance. 2012. (accessed 1 November 2016)

Kayem G, Kurinczuk J, Lewis G, Golightly S, Brocklehurst P, Knight M Risk factors for progression from severe maternal morbidity to death: a national cohort study. PLoS One. 2011; 6:(12)

In: Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J, Kurinczuk JJ (eds). Oxford: National Perinatal Epidemiology Unit; 2014

National Blood Transfusion Committee. 2016. (accessed 1 November 2016)

National Institute for Health and Care Excellence. Blood transfusion. 2015. (accessed 1 November 2016)

National Patient Safety Agency. Right patient, right blood. NPSA/2008/SPN14. 2006. (accessed 1 November 2016)

National Patient Safety Agency. Rapid Response Report NPSA/2010/017. The transfusion of blood and blood components in an emergency. 2010. (accessed 1 November 2016)

NHS Blood and Transplant. 2014. (accessed 1 November 2016)

NHS Blood and Transplant. 2016. (accessed 1 November 2016)

NHS Litigation Authority. Maternity Claims – Information Sheet 5: Caesarean Section. 2010. (accessed 14 November 2016)

Section 5: Adverse effects of transfusion, 5th edn. In: Norfolk D Norwich: TSO; 2013

London: NMC; 2012

London: NMC; 2015

Royal College of Obstetricians and Gynaecologists. 2014. (accessed 1 November 2016)

Royal College of Obstetricians and Gynaecologists. Green-top Guideline No. 47. 2015. (accessed 1 November 2016)

Manchester: SHOT; 2015a

Manchester: SHOT; 2015b

Guideline on the investigation and management of acute transfusion reactions. 2012. (accessed 1 November 2016)

Watson D, Murdock J, Doree C, Murphy M, Roberts M, Blest A, Brunskill S Blood transfusion administration—one- or two-person checks: which is the safest method?. Transfusion. 2008; 48:(4)783-9

Blood transfusion in the context of maternity care

02 December 2016
13 min read
Volume 24 · Issue 12


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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