Blood Availability and Maternal Mortality from Obstetric Hemorrhage: A Retrospective Case-Control and Cross-Sectional Study in Kenya

Introduction: Obstetric hemorrhage is a leading cause of maternal death in Kenya, yet limited access to timely blood transfusions remains a persistent challenge. Understanding how maternal deaths relate to blood availability is critical to improving outcomes in resource-limited settings. Objectives: To (1) identify clinical and systemic factors associated with hemorrhagic versus non-hemorrhagic maternal deaths, and (2) evaluate the impact of hospital-based blood bank implementation on blood availability and maternal mortality. Methodology: We conducted two retrospective analyses at Nakuru Level 6 Hospital, Kenya (January 1, 2019–June 30, 2022): a case-control study comparing maternal deaths due to obstetric hemorrhage (cases) versus non-hemorrhagic causes (controls) using univariate and multivariable logistic regression (p < 0.10 inclusion threshold, adjusted for age and parity); and a repeated cross-sectional study comparing monthly blood units dispatched to the maternity ward, transfusion rates, and maternal mortality before and after implementation of a hospital-based blood bank (June 2020) using Wilcoxon rank-sum exact tests. Poisson regression, adjusting for monthly live births, modeled the association between blood units and hemorrhagic deaths. Results: Among 90 maternal deaths, 33 (36.7%) were due to obstetric hemorrhage. In the case–control analysis, lack of blood products was associated with nearly 20-fold higher odds of hemorrhagic death (OR 19.91, 95% CI 2.23–177.97, p = 0.01). In the repeated cross-sectional analysis, blood availability after development of a local blood bank did not significantly change monthly hemorrhagic deaths (mean ± SD: 1.0 ± 1.0 vs. 0.0 ± 1.0, p = 0.22) or blood units dispatched to the maternity ward (88 ± 16 vs. 87 ± 16, p > 0.99). However, each additional blood unit delivered was associated with a 5% lower incidence rate of hemorrhagic death (IRR 0.95, p = 0.07). Conclusion: Lack of blood availability is associated with hemorrhagic deaths, underscoring the need for robust, locally adaptive blood systems and strategies to address delays in care-seeking in obstetric emergencies.