{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T14:46:06Z","timestamp":1790952366295,"version":"4.1.0"},"reference-count":14,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T00:00:00Z","timestamp":1681689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Postpartum hemorrhage (PPH) is one of the leading causes of obstetric complications. The goal of this study was to identify risk factors for obstetric (OB) massive transfusion (MT) and determine the feasibility of developing a low\u2010titer group O RhD\u2010positive whole blood (LTO\u2009+\u2009WB) protocol for OB hemorrhage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design and Methods<\/jats:title><jats:p>A retrospective study of OB patients who received transfusion within 24\u2009h. MT patients were those who received &gt;3\u2009U of pRBC within 1\u2009h or\u2009&gt;\u200910\u2009U in 24\u2009h. Patient demographics, OB history, comorbidities, blood type, antibody status, and known risk factors for PPH and maternal\u2010fetal outcomes were compared. Logistic regression was used for univariate and multivariate analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 610 transfused OB patients, 12.0% (<jats:italic>n<\/jats:italic>\u2009=\u200973) required MT. Groups were well matched for body mass index (BMI), maternal comorbidities, and history of spontaneous vaginal deliveries. The incidence of the previous cesarean section was higher in the MT group. Exactly 93.9% of patients were RhD\u2010positive and 3.77% of all patients possessed an antibody on pretransfusion testing. Patients with MT had a longer length of stay (LOS), higher rate of intensive care unit (ICU) admission, fetal death, and hysterectomy. Multivariate analysis found age &gt;35, PPH, placenta percreta, accreta, and increta to be significant (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.05) risk factors for MT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Patients over 35\u2009years and those with abnormal placentation are at increased risk of requiring MT. With a time to delivery of 2\u2009days, potential MT patients can be identified early, and with a 94% rate of RhD\u2010positive+, they are eligible to receive low\u2010titer O whole blood (LTOWB) providing hemostatic resuscitation with reduced donor exposure.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.17331","type":"journal-article","created":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T13:36:05Z","timestamp":1681738565000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Risk factors for massive transfusion in obstetrical hemorrhage and consideration of a whole blood program"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2608-8165","authenticated-orcid":false,"given":"John C.","family":"Myers","sequence":"first","affiliation":[{"name":"Department of Surgery UT Health San Antonio  San Antonio Texas 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