Historically, one of the major arguments against an elective cesarean delivery was that of blood loss due to the operation. Thus it is of great value and importance that Holm et al. show that planned caesarean delivery is associated with less risk of postpartum hemorrhage (PPH) and blood transfusion compared to intended vaginal delivery. The authors conclude that while counseling the patient prior to delivery this finding should be mentioned, especially if the patient is worried about blood loss and/or blood transfusion (e.g. Jehovah’s Witness patients).
The lowest rate of red blood cell (RBC) transfusion was seen in women who had an elective caesarean delivery without prior birth. Women who planned a vaginal birth after a previous cesarean section and women who planned a cesarean section after a vaginal birth all had an increased risk of blood transfusion.
The weakness of the study lies in the fact that in Denmark the rate of RBC transfusion seems considerably high, i.e. the critical threshold to receive a transfusion in obstetrics is questionable. Surely a more restrictive transfusion practice would influence the results. However, the data were collected in a high number of patients, actually more than 380,000, which rules out a minority bias. In summary, it is a most interesting study which gives valuable information concerning the mode of delivery and risk of RBC transfusion.
– Christian Breymann