Variability in Blood Transfusion Practices and Determinants of Transfusion Decisions in Obstetric and Gynecological Care: A Prospective Audit at A Tertiary Care Hospital

Background: Blood transfusion is a critical intervention in obstetric and gynecological practice but is associated with significant variability in indications and thresholds. Inconsistent transfusion practices may compromise patient safety and lead to inefficient use of scarce blood resources.

Objectives: To assess the variability in blood transfusion practices in obstetric and gynecological care, evaluate the role of clinical examination and laboratory parameters in transfusion decisions, and identify areas for improvement to enhance patient safety and blood utilization efficiency.

Methods: A prospective observational audit was conducted in the Department of Obstetrics and Gynecology at a tertiary care hospital over a seven-month period (March–September 2025). All obstetric and gynecological patients receiving blood transfusion during hospitalization were included. Demographic, clinical, laboratory, and transfusion-related data were collected using a structured proforma. Transfusion practices were analyzed for variability based on anemia severity, clinical presentation, and diagnosis. Data were analyzed using SPSS version 23. Categorical variables were compared using Chi-square or Fisher’s exact test, and odds ratios with 95% confidence intervals were calculated. A p-value <0.05 was considered statistically significant.

Results: A total of 160 transfused patients were included, comprising 91 obstetric (56.9%) and 69 gynecological (43.1%) patients. Obstetric patients were significantly younger, while gynecological patients predominantly belonged to the peri- and post-menopausal age groups (p <0.001). Moderate anemia was the most common indication for transfusion among obstetric patients, whereas severe anemia and active bleeding predominated in gynecological patients (p <0.001). Gynecological patients had significantly higher odds of severe anemia and multi-unit transfusion. Packed red blood cells were used universally, reflecting adherence to component therapy. Non-transfusion anemia management strategies were underutilized, particularly in gynecological patients. Transfusion reactions were rare, indicating overall procedural safety.

Conclusions: Substantial variability exists in transfusion decision-making in obstetric and gynecological care. Greater reliance on clinical assessment, standardized transfusion thresholds, and systematic implementation of patient blood management strategies are needed to reduce avoidable transfusions, enhance patient safety, and optimize blood resource utilization.