Association of Gestational Age with Postpartum Hemorrhage: An International Cohort Study

Abstract

Background Risk factors for postpartum hemorrhage, such as chorioamnionitis and multiple gestation, have been identified in previous epidemiologic studies. However, existing data describing the association between gestational age at delivery and postpartum hemorrhage are conflicting. The aim of this study was to assess the association between gestational age at delivery and postpartum hemorrhage. Methods The authors conducted a population-based retrospective cohort study of women who underwent live birth delivery in Sweden between 2014 and 2017 and in California between 2011 and 2015. The primary exposure was gestational age at delivery. The primary outcome was postpartum hemorrhage, classified using International Classification of Diseases, Ninth Revision—Clinical Modification codes for California births and a blood loss greater than 1,000 ml for Swedish births. The authors accounted for demographic and obstetric factors as potential confounders in the analyses. Results The incidences of postpartum hemorrhage in Sweden (23,323/328,729; 7.1%) and in California (66,583/2,079,637; 3.2%) were not comparable. In Sweden and California, the incidence of postpartum hemorrhage was highest for deliveries between 41 and 42 weeks’ gestation (7,186/75,539 [9.5%] and 8,921/160,267 [5.6%], respectively). Compared to deliveries between 37 and 38 weeks, deliveries between 41 and 42 weeks had the highest adjusted odds of postpartum hemorrhage (1.62 [95% CI, 1.56 to 1.69] in Sweden and 2.04 [95% CI, 1.98 to 2.09] in California). In both cohorts, the authors observed a nonlinear (J-shaped) association between gestational age and postpartum hemorrhage risk, with 39 weeks as the nadir. In the sensitivity analyses, similar findings were observed among cesarean deliveries only, when postpartum hemorrhage was classified only by International Classification of Diseases, Tenth Revision—Clinical Modification codes, and after excluding women with abnormal placentation disorders. Conclusions The postpartum hemorrhage incidence in Sweden and California was not comparable. When assessing a woman’s risk for postpartum hemorrhage, clinicians should be aware of the heightened odds in women who deliver between 41 and 42 weeks’ gestation. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Design of a postpartum hemorrhage and transfusion risk calculator

“…These findings do not correspond to the findings of a study comparing the incidence of PPH in Sweden and California and the risk of PPH associated with gestational age, where the risk is higher in deliveries between 41 and 42 weeks compared to deliveries between 37 and 38 weeks [ 44 ].…”

Study the incidence, management and outcome of primary postpartum hemorrhage in a tertiary care hospital

“…The reason for the same could be biologic or pathologic connections like reduced myometrial contractility (including reduced contractile response to exogenous oxytocin), altered placentation and other etiologies with risk of hemorrhage. 6 Butwick et al reported higher odds of PPH after 38 weeks especially between 41-42 weeks. 7,8 In 58% of patients in our study primary PPH was noted after delivery of good size baby i.e., weight was more than 3.5 kg.…”

“…The incidence is comparable to the reported incidence of (2-10%) by Butwick et al a systematic review reported the highest rate of PPH in Africa 27.5% and lowest in Oceania (7.2%) with an overall rate globally of 10.8%. 6,7 In the present study, profile of 200 patients developing primary PPH was analysed on basis of socio-demographic parameters (age, residence), period of gestation, birth weight of baby, history of previous PPH, hemoglobin levels, type of PPH, mode of delivery, onset of labor, management of third stage of labor, different treatment modalities received and outcome. In our study 84% of the patients belonged to rural areas with low socio -economic status.…”

Investigación multidisciplinaria desde una visión multidisciplinar. Libro 1

“…En la revisión realizada se evidenció por Thawai V. et.al., que casi la mitad de las mujeres estudiadas presentaron HPP siendo las causas más comunes la atonía uterina seguida de un traumatismo perineal, igual resultado obtuvieron Nsangamay N, y Mash R, quienes además constataron diagnóstico tardío de HPP por falta de seguimiento eficaz posparto (Thawal et al, 2019), en tanto Butwick AJ, et.al., identificaron que la edad gestacional entre 41 y 42 semanas tienen mayor probabilidad de terner HPP (Butwick et al, 2021).…”