OBJECTIVE: Data suggest type O blood has a higher propensity for hemorrhage, although the literature on postpartum hemorrhage (PPH) is mixed and does not separate by mode of delivery. Our objective was to assess the relationship between PPH and ABO blood type by mode of delivery. STUDY DESIGN: This is a retrospective cohort study of all singleton gestations delivered after 34 weeks identified by the PeriBank database of Baylor College of Medicine January 2011-March 2018. Exclusion criteria were sickle cell disease, use of anticoagulant medications other than Aspirin 81 mg, and multiple gestations. Data were abstracted from the PeriBank regarding demographics and delivery outcomes. Analyses were conducted separately for cesarean delivery (CD) and vaginal delivery (SVD). Significant demographic differences between groups were controlled for in multivariate logistical regression. Quantitative variables were analyzed with ANOVA and categorical variables with chi squared. The primary outcome was the rate of PPH by blood type (A, B, AB, and O), defined as blood loss >500 cc in SVD and >1000 cc in CD. RESULTS: 32,023 women met inclusion criteria (SVD 22,484 (70.2%), CD 9,539 (29.8%)). Significant demographics differences between blood types included age, parity, race, induction of labor, regional anesthesia, and thrombocytopenia in the SVD group. In the CD group, age, parity, and race were significantly different between blood types. There was no observed difference in the rate of PPH by blood type for those who delivered via SVD (p¼0.4), including when controlling for demographic differences in logistic regression (p¼0.2). In the CD group, there was a significantly higher rate of PPH in women with type O blood (5.2% type O vs 3.8% type A vs 4.4% type B vs 4.2% type AB, p¼0.035), including when controlling for demographic differences (p¼0.02). In both SVD and CD groups, there was no difference in any of the secondary outcomes including blood transfusions, hysterectomies, intrapartum D+C, and ICU admission. CONCLUSION: Type O blood may be an additional risk factor for PPH at the time of CD.
most studies were performed in countries with high numbers of recommended prenatal visits and focused on perinatal outcomes. Our aim was to assess the association between prenatal care utilization (PCU) and both severe maternal and perinatal morbidities (SM). STUDY DESIGN: Data source was the PreCARE prospective cohort study conducted in 2010-2012 in 4 maternity units of the north Parisian area (France). Our sample was restricted to the 9117 women with singleton pregnancies delivered after 21 completed weeks of gestation (WG). Various measures of PCU were used: 1) initiation of care before 14 WG, 2) rate of completed visits on recommended visits according to WG, 3) absence of the first, second or third trimester ultrasounds, 4) two modified Adequacy of Prenatal Care Utilization indexes (APNCU) combining the 3 previous components (Figure 1). Main outcomes were two composite variables of 1) maternal SM (SMM) and 2) perinatal SM (SPM). To assess the association between PCU and SM, logistic regression models were used to adjust for maternal characteristics. RESULTS: Late initiation of care affected 17% of women while 3% had less than 50% of the recommended visits, 22% no first ultrasound, 17% no second and 16% no third trimester ultrasound. According to the modified APNCU-2 index, 35% of women had an inadequate PCU. SMM occurred in 2.9% of women and SPM in 5.5% of babies and were independently associated with various measures of PCU as presented in figure 2. The strength of the association varied with the component of PCU considered and whether the outcome was SMM or SPM. CONCLUSION: Despite a universal access to health care insurance during pregnancy, the rate of inadequate PCU is important in this area of France and is associated to increased risks of perinatal and maternal SM.
OBJECTIVE: Preeclampsia (PE) is a condition unique to pregnancy, and presents with a variable phenotypic expression in the mother and fetus. Increased plasma levels of anti-angiogenic VEGF receptor protein (sFlt-1) has been implicated in the pathogenesis of PE. The placenta remains the main source of sFlt-1 during pregnancy and PE. Growing evidence suggests that additional sources of sFlt-1 exist, such as maternal peripheral blood mononuclear cells (PBMCs). We aim to further characterize the PBMC contribution in PE. STUDY DESIGN: Plasma sFlt-1 levels were measured by ELISA in normal pregnancies (NP) and PE pregnancies using 2 collection tubes, EDTA and CTAD. The CTAD tubes prevent platelet activation and the PBMC release of sFlt-1. In addition, we performed heparin agarose enrichment of sFlt1 with Western blot analysis. Co-culture experiments were performed by incubating placental villous explants and PBMCs. We measured the sFlt-1 mRNA levels by real time PCR to determine the effect of co-culture. Data are presented as mean and significant at p<0.05. RESULTS: Plasma levels of sFlt-1 in women with PE (n¼12) was significantly higher than the levels in women with NP (n¼6) for both EDTA and CTAD tubes (p<.05) estimated by ELISA. sFlt-1 levels in CTAD plasma were 15% lower than in EDTA plasma (p<0.05) indicating that maternal PBMCs contribute to sFlt-1 production in both NP (14.6%, p<0.05) and PE women (16.7%, p<0.05). This was confirmed by Western blot. Real time PCR estimation of sFlt-1 mRNA shows a 3-fold increase in PE PBMCs co-cultured with PE placental villous explants (p<0.05) compared to PBMCs cultured alone. CONCLUSION: Our data suggests that maternal PBMC and placental interaction is important in the overexpression of sFlt-1. Additionally, our data support that PBMCs contribute significantly to PE pathology. PE is a unique disease in that the mother exhibits the significant phenotype, despite the placenta as the main source of sFlt-1. We speculate that intervention targeting PBMCs rather than the placenta to control PE may be more beneficial to promote better pregnancy outcomes.
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