Objectives: In obstetrics, transfusion medicine is involved because of the risk of Rh isoimmunisation and of transfusion at delivery. In France, although these two situations have led to legal or professional recommendations, practices appear to be very different from one institution or one physician to another.
Study design: Retrospective study.
Methods: A questionnaire using both direct questions and clinical cases was sent to all members of the French obstetric anaesthetists association (named CARO).
Results: One hundred and seventy-eight questionnaires (response rate 17.1%) were returned. Monitoring of anti-D antibody concentrations during pregnancy was performed in accordance with the legal recommendation (14/02/1992) in only 3.9% (Rh+) and 19% (Rh-) of women. Blood samples were performed either too often or too rarely in 39 to 72% of responses. At delivery, an immediate assessment of anti-D antibody concentration was required in almost 100% by the specialist on call in the blood bank while this measurement was considered necessary by only 80% of anaesthetists responding to the questionnaire. The distance between the maternity and the blood bank is greater than 14 km in 19% of responses and the largest time interval reported to obtain red cell concentrates was greater than 145 min in 18% of responses. Autologous blood transfusion is described as being used routinely in only 23% of responses.
Conclusion: Significant failures in practice patterns and organisation of care are suggested by the responses to this questionnaire. This should stimulate a national debate to improve adequacy of practices to legal and professional recommendations and to review blood distribution to maternities in this country.