Blood transfusion practices in patients undergoing cesarean section. A multicenter prospective investigation.Introduction: There has been a dramatic increase in the rate of cesarean section (CS) over the past two decades, making it the most commonly performed procedure worldwide. 1Surveys (2, 3) have indicated that 3–5% of total red blood cell transfusions are obstetric-related, with a higher rate in patients with CS than in those with vaginal births (1–7 % versus 1%) (4, 5).Transfusion in the CS requires special attention because this procedure is performed in relatively young patients who are generally free of serious comorbidities and have approximately four to five decades of life ahead of them. Ideally, these patients do not need blood replacement because the long-term complications of allogeneic transfusion have a greater impact on them (23). In recent years, there has been increased awareness regarding the potential risk of blood transfusion, which has led to increased scrutiny of its use. by health care providers. (6). Studies have shown that in the 1990s, transfusion for CS had decreased to 1.1-1.6% (7, 8) in some centers but remained relatively high (5.2-6.8%) in others. others (9, 10). A review of the available literature shows that the need for transfusion varies between countries. (11-14) Most existing data on cesarean transfusion are retrospective and concern developed countries. (15, 16). In Pakistan, few studies have been conducted on this topic. A small retrospective study, carried out at a teaching hospital in Karachi on 126 patients undergoing cesarean section, found a transfusion rate of 15%. (17) This study did not reflect a larger proportion of patients in our country because blood transfusion practices vary depending on the establishments in operation...... middle of article...... identification and rectification of factors leading to this high transfusion rate. We identified CS as the most common factor requiring blood transfusion, highlighting the need to reduce the rate of CS. Being a third world country with limited resources, we recommend the need to develop national guidelines for the process of blood transfusion in obstetric patients. The prescribing physician should follow these guidelines based on the patient's condition at the time. The importance of discussing and obtaining informed consent is that the process should be more systematic and cover medico-legal aspects as well. As anemia is quite prevalent in our obstetric population, it is also very important to use anemia treatment strategies during pregnancy, which can reduce the risk of blood transfusion (5 of f) during the perioperative period..