Predictors of Blood Transfusion Following Cesarean Delivery in Resource-Constrained Settings: The Impact of Out-of-Hours Surgery
7 affiliations
- 1Department of Obstetrics and Gynecology, “Victor Babeș” University of Medicine and Pharmacy Timișoara, Eftimie Murgu Square No. 2, 300041 Timișoara, Romania
- 2Clinic of Obstetrics and Gynecology, County Emergency Clinical Hospital “Pius Brînzeu”, 300723 Timișoara, Romania
- 3Department for the Prevention and Control of Healthcare-Associated Infections (CPIAAM), Clinical Hospital of Infectious Diseases and Pulmonology “Dr. Victor Babeș” Timișoara, Gheorghe Adam Street No. 13, 300310 Timișoara, Romania
- 4Doctoral School, “Victor Babeș” University of Medicine and Pharmacy Timișoara, Eftimie Murgu Square No. 2, 300041 Timișoara, Romania
- 5Obstetrics and Gynecology Clinic I, Timișoara Municipal Emergency Clinical Hospital, 300079 Timișoara, Romania
- 6Department of Obstetrics and Gynecology, Municipal Hospital Deva, 330084 Deva, Romania
- 7Obstetrics-Gynecology Clinic IV, Timișoara Municipal Emergency Clinical Hospital, 300079 Timișoara, Romania
Abstract
Background/Objectives: Perioperative red blood cell (RBC) transfusion after cesarean delivery reflects both obstetric hemorrhagic risk and the capacity of the care environment. We evaluated whether out-of-hours cesarean delivery was independently associated with transfusion in a Romanian tertiary maternity unit operating under constrained resources. Methods: We conducted a retrospective unmatched case–control study of cesarean deliveries performed from 2023 to 2025. All eligible transfused women were included as cases; two non-transfused controls per case were randomly selected within each calendar year. Eligibility required preoperative hemoglobin ≥ 10 g/dL and normal coagulation. The primary exposure was out-of-hours surgery, and multivariable logistic regression adjusted for maternal, obstetric, placental, and hematological factors. Results: The source population contained 6773 cesarean deliveries, with 608 transfusions (9.0%). The analytical sample comprised 401 cases and 802 controls. Out-of-hours procedures occurred in 64.1% of cases and 52.5% of controls (crude OR 1.62, 95% CI 1.26–2.07). After adjustment, out-of-hours delivery remained associated with transfusion (aOR 2.03, 95% CI 1.45–2.84). Placenta previa, suspected placenta accreta spectrum, and lower preoperative hemoglobin were the strongest clinical predictors. When postoperative/pre-transfusion hemoglobin was added, the out-of-hours association attenuated to an aOR of 1.02 (95% CI 0.63–1.65); sensitivity analyses remained consistent with the primary model. Conclusions: Out-of-hours cesarean delivery was associated with approximately two-fold higher transfusion odds after adjustment for the measured clinical factors. Because cesarean indication, urgency, and labor characteristics were not available, this association may partly reflect the different case mix and acuity of out-of-hours surgery rather than the working period itself. Attenuation after adjustment for post-exposure hemoglobin is compatible with, but does not establish greater perioperative blood loss. In high-cesarean, resource-constrained settings, standardized hemorrhage-risk identification and equivalent preparedness across duty periods warrant prospective evaluation in studies that also record indication and urgency.
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BibTeX
@article{muresan2026predictors,
title = {{Predictors of Blood Transfusion Following Cesarean Delivery in Resource-Constrained Settings: The Impact of Out-of-Hours Surgery}},
author = {Cezara Muresan and Marius Biriș and Răzvan Roșca and Andrei Pescaru and Cosmin Cîtu and Jasmina Chiriac and Denis Mihai Șerban and Răzvan Betea and Sebastian Ciurescu and Victor Bogdan Buciu},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218646},
url = {https://www.mdpi.com/2077-0383/15/21/8646},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Predictors of Blood Transfusion Following Cesarean Delivery in Resource-Constrained Settings: The Impact of Out-of-Hours Surgery
AU - Cezara Muresan
AU - Marius Biriș
AU - Răzvan Roșca
AU - Andrei Pescaru
AU - Cosmin Cîtu
AU - Jasmina Chiriac
AU - Denis Mihai Șerban
AU - Răzvan Betea
AU - Sebastian Ciurescu
AU - Victor Bogdan Buciu
PY - 2026
DA - 2026/11/06
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218646
UR - https://www.mdpi.com/2077-0383/15/21/8646
AB - Background/Objectives: Perioperative red blood cell (RBC) transfusion after cesarean delivery reflects both obstetric hemorrhagic risk and the capacity of the care environment. We evaluated whether out-of-hours cesarean delivery was independently associated with transfusion in a Romanian tertiary maternity unit operating under constrained resources. Methods: We conducted a retrospective unmatched case–control study of cesarean deliveries performed from 2023 to 2025. All eligible transfused women were included as cases; two non-transfused controls per case were randomly selected within each calendar year. Eligibility required preoperative hemoglobin ≥ 10 g/dL and normal coagulation. The primary exposure was out-of-hours surgery, and multivariable logistic regression adjusted for maternal, obstetric, placental, and hematological factors. Results: The source population contained 6773 cesarean deliveries, with 608 transfusions (9.0%). The analytical sample comprised 401 cases and 802 controls. Out-of-hours procedures occurred in 64.1% of cases and 52.5% of controls (crude OR 1.62, 95% CI 1.26–2.07). After adjustment, out-of-hours delivery remained associated with transfusion (aOR 2.03, 95% CI 1.45–2.84). Placenta previa, suspected placenta accreta spectrum, and lower preoperative hemoglobin were the strongest clinical predictors. When postoperative/pre-transfusion hemoglobin was added, the out-of-hours association attenuated to an aOR of 1.02 (95% CI 0.63–1.65); sensitivity analyses remained consistent with the primary model. Conclusions: Out-of-hours cesarean delivery was associated with approximately two-fold higher transfusion odds after adjustment for the measured clinical factors. Because cesarean indication, urgency, and labor characteristics were not available, this association may partly reflect the different case mix and acuity of out-of-hours surgery rather than the working period itself. Attenuation after adjustment for post-exposure hemoglobin is compatible with, but does not establish greater perioperative blood loss. In high-cesarean, resource-constrained settings, standardized hemorrhage-risk identification and equivalent preparedness across duty periods warrant prospective evaluation in studies that also record indication and urgency.
SN - 2077-0383
ER -