{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T21:56:47Z","timestamp":1789768607144,"version":"4.0.1"},"reference-count":43,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2021,9,28]],"date-time":"2021-09-28T00:00:00Z","timestamp":1632787200000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"WHO","award":["CHN-12-MCN-004888"],"award-info":[{"award-number":["CHN-12-MCN-004888"]}]},{"name":"National Health Commission of the People\u2019s Republic of China, the China Medical Board","award":["11-065"],"award-info":[{"award-number":["11-065"]}]},{"DOI":"10.13039\/100006641","name":"UNICEF","doi-asserted-by":"publisher","award":["2016EJH016"],"award-info":[{"award-number":["2016EJH016"]}],"id":[{"id":"10.13039\/100006641","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key R&D Program of China","doi-asserted-by":"crossref","award":["2019YFC1005100"],"award-info":[{"award-number":["2019YFC1005100"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,9,16]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aims to use the high-quality national monitoring data from the China\u2019s National Maternal Near Miss Surveillance System (NMNMSS) to ascertain the incidence, trends and risk factors of obstetric massive blood transfusion (MBT) from 2012 to 2019 in China and determine its clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Settings<\/jats:title>\n                    <jats:p>Observational study of hospitalised pregnancies who had given birth or ended their pregnancy among member hospitals of NMNMSS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>11 667 406\u2009women were included in this study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>We screened for the incidence, trends, risk factors and main reasons for obstetric MBT, and the outcomes after obstetric MBT. MBT was defined as the transfusion of \u22655 units of red blood cells or \u22651000\u2009mL of whole blood. The incidence of MBT was defined as the MBT cases per 10\u2009000 pregnancies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Obstetric MBT occurred in 27\u2009626 cases, corresponding to an incidence of 23.68 per 10\u2009000 maternities, which exhibited an increasing trend in China during 2012\u20132019 (14.03\u201329.59 per 10\u2009000 maternities, p for trend &lt;0.001). Obstetric MBT was mainly associated with amniotic fluid embolism, uterine atony, abnormal placenta, severe anaemia, ectopic pregnancy, abortion, caesarean section, advanced maternal age and multiparous from biological effect. While from sociological effects, uterine atony, severe anaemia and placenta previa are the top three complications which more likely to undergo obstetric MBT in the Chinese population. Overall, the secular trends of hysterectomy incidence (25.07%\u20139.92%) and MMR during hospitalisation (21.41\u2030\u20137.48\u2030) among women who underwent MBT showed decreasing trends (p for trend &lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>To minimise the incidence of obstetric MBT, more attention should be paid to education on the importance of the antenatal visit, evidence-based transfusion practice and females who are multiparous and have an advanced age, amniotic fluid embolism, uterine atony, severe anaemia and placenta previa.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-047983","type":"journal-article","created":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T00:47:18Z","timestamp":1632876438000},"page":"e047983","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Incidence, trends and risk factors for obstetric massive blood transfusion in China from 2012 to 2019: an observational study"],"prefix":"10.1136","volume":"11","author":[{"given":"Yanxia","family":"Xie","sequence":"first","affiliation":[{"name":"National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Liang","sequence":"additional","affiliation":[{"name":"National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, Sichuan, 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