| Evolving perspectives on blood transfusion in obstetric hemorrhage: a narrative review |
Yoon Ji Choi1 
, Sang Hun Kim2,3
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1Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
2Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea
3Department of Anesthesiology and Pain Medicine, College of Medicine, Chosun University, Gwangju, Korea |
Corresponding author:
Sang Hun Kim, Tel: +82-62-220-3578, Fax: +82-62-223-2333,
Email: ksh3223@chosun.ac.kr
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Received: 18 May 2025 • Revised: 27 August 2025 • Accepted: 29 August 2025 |
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| Abstract |
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Globally, postpartum hemorrhage is still among the most significant factors in preventable maternal morbidity and mortality. Although early recognition and intervention have improved with advances in obstetric care, transfusion practices are often based on fixed thresholds that may not accurately reflect the unique physiological changes that occur during pregnancy or in the clinical context of acute bleeding. In this narrative review, we propose a phase-specific, patient-centered transfusion strategy for the preoperative, intraoperative, and postpartum periods. Key components of this strategy include proactive anemia correction during pregnancy, timely administration of uterotonic agents, early implementation of antifibrinolytic therapy, such as tranexamic acid within 3 h of bleeding onset, and appropriate activation of massive transfusion protocols when severe hemorrhage is ongoing. Clinical decision-making should be based on continuous assessment of maternal status, rather than on static hemoglobin values. Point-of-care coagulation monitoring, including thromboelastography and rotational thromboelastometry, can allow rapid identification of coagulopathy and support goal-directed transfusion. For high-risk populations, such as those with placenta accreta spectrum or those who decline allogeneic transfusion, strategies can include intraoperative cell salvage and non-blood interventions. Balanced transfusion approaches, using equal ratios of red blood cells, plasma, and platelets, at an early stage have demonstrated improved outcomes. Standardized protocols, multidisciplinary collaboration, and the integration of emerging technologies may further improve safety, minimize unnecessary transfusions, and promote consistency of care in the management of obstetric hemorrhage. |
| Key Words:
Anemia; Antifibrinolytic agents; Blood component transfusion; Hematinics; Operative blood salvage; Oxytocics; Point-of-care systems; Postpartum hemorrhage; Thromboelastography |
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