Assessment of post‐partum haemorrhage risk among women with moderate thrombocytopenia

Arcudi, Sara; Ronchi, Alice; Capecchi, Marco; Iurlaro, Enrico; Ossola, Manuela Wally; Mancini, Ilaria; Schivardi, Gabriella; Marconi, Anna Maria; Podda, Gian Marco; Artoni, Andrea

doi:10.1111/bjh.18098

Cited by 7 publications

(6 citation statements)

References 25 publications

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“…A study of 1,085 women with twin gestations found a greater incidence of PPH in women with mild thrombocytopenia compared with those with normal platelet count ( 10 ). Additionally, moderate thrombocytopenia ( 22 ) and severe thrombocytopenia ( 8 ) were also convinced to be risk factors for PPH in twin pregnancies. Based on these findings, ( 8 , 10 , 22 ) a conclusion that thrombocytopenia in pregnancy was associated with PPH regardless of its severity could be deduced.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, moderate thrombocytopenia ( 22 ) and severe thrombocytopenia ( 8 ) were also convinced to be risk factors for PPH in twin pregnancies. Based on these findings, ( 8 , 10 , 22 ) a conclusion that thrombocytopenia in pregnancy was associated with PPH regardless of its severity could be deduced. In addition, our study demonstrated that gestational thrombocytopenia was indeed more common in women with PPH.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for postpartum hemorrhage in twin pregnancies with cesarean section

Lan,

Xu,

et al. 2024

Front. Med.

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The rates of twin pregnancies and cesarean section have increased in recent years, and both of them are at high risks of postpartum hemorrhage (PPH). However, few studies have concentrated on the risks of PPH in twin pregnancies and cesarean deliveries. In this study, we aimed to identify the risk factors for PPH among twin-pregnant women with cesarean section. This was a retrospective observational study including 1,649 women with twin pregnancies delivered by cesarean section from 2016 to 2022 in the Second Affiliated Hospital of Wenzhou Medical University, China. The eligible women were divided into PPH group (n = 116) and non-PPH group (n = 1,533) according to the blood loss after delivery within 24 h. The baseline maternal and perinatal characteristics were compared between the two groups. Logistic regression analysis was conducted to identify the potential risk factors for PPH. We found nulliparity, assisted reproductive technology (ART) usage, preeclampsia or HELLP syndrome, placenta previa, placenta accreta and general anesthesia were more common in PPH group than non-PPH group (P < 0.05). Women in PPH group had higher maternal body mass index at delivery and higher combined birthweight of the twins than non-PPH group, but had lower parity (P < 0.05). Seven independent risk factors for PPH were identified after logistic regression analysis: ART usage (OR 2.354 95% CI 1.357–4.083, P = 0.002), preeclampsia or HELLP syndrome (OR 2.605, 95% CI 1.471–4.616, P = 0.001), placenta previa (OR 7.325, 95% CI 3.651–14.697, P < 0.001), placenta accreta (OR 6.296, 95% CI 1.316–30.12, P = 0.021), thrombocytopenia (OR 1.636, 95% CI 1.056–2.535, P = 0.027), general anesthesia (OR 2.394, 95% CI 1.223–4.686, P = 0.011), and combined birthweight (OR 1.00032, 95% CI 1.00005–1.00059, P = 0.020). Collectively, in women with twin pregnancies delivered by cesarean section, the use of ART, preeclampsia or HELLP syndrome, placenta previa, placenta accreta, thrombocytopenia, general anesthesia and the combined birthweight were identified as independent risk factors for PPH. More attention should be paid to women with these risk factors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk factors for postpartum hemorrhage in twin pregnancies with cesarean section

Lan,

Xu,

et al. 2024

Front. Med.

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“…PPH is defined as primary if the bleeding occurs before delivery of the placenta and up to 24 h after delivery of the fetus, or secondary if it occurs more than 24 h after delivery 9 . PPH risk factors include antepartum haemorrhage, augmented or induced labour, instrumental or caesarean delivery, chorioamnionitis, foetal macrosomia, polyhydramnios, maternal anaemia, thrombocytopenia or hypofibrinogenaemia, maternal obesity, multifetal gestation, preeclampsia, prolonged labour, placentation abnormalities and older age 18–25 . Hereditary haemostatic disorders and a history of PPH in a previous delivery also increase the risk 20,26,27 .…”

Section: Causes and Pathophysiology Of Postpartum Haemorrhagementioning

confidence: 99%

“…9 PPH risk factors include antepartum haemorrhage, augmented or induced labour, instrumental or caesarean delivery, chorioamnionitis, foetal macrosomia, polyhydramnios, maternal anaemia, thrombocytopenia or hypofibrinogenaemia, maternal obesity, multifetal gestation, preeclampsia, prolonged labour, placentation abnormalities and older age. [18][19][20][21][22][23][24][25] Hereditary haemostatic disorders and a history of PPH in a previous delivery also increase the risk. 20,26,27 However, it is estimated that about 40% of PPH cases occur in women who do not have any risk factors, emphasising the importance of surveillance in all women.…”

Section: Causes and Pathophysiology Of Postpartum Haemorrhagementioning

confidence: 99%

Haemostatic support in postpartum haemorrhage

Hofer

Bláha

Collins

et al. 2022

European Journal of Anaesthesiology

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Postpartum haemorrhage (PPH) remains the leading cause of pregnancy-related deaths worldwide. Typically, bleeding is controlled by timely obstetric measures in parallel with resuscitation and treatment of coagulopathy. Early recognition of abnormal coagulation is crucial and haemostatic support should be considered simultaneously with other strategies as coagulopathies contribute to the progression to massive haemorrhage. However, there is lack of agreement on important topics in the current guidelines for management of PPH. A clinical definition of PPH is paramount to understand the situation to which the treatment recommendations relate; however, reaching a consensus has previously proven difficult. Traditional definitions are based on volume of blood loss, which is difficult to monitor, can be misleading and leads to treatment delay. A multidisciplinary approach to define PPH considering vital signs, clinical symptoms, coagulation and haemodynamic changes is needed. Moreover, standardised algorithms or massive haemorrhage protocols should be developed to reduce the risk of morbidity and mortality and improve overall clinical outcomes in PPH. If available, point-of-care testing should be used to guide goal-directed haemostatic treatment. Tranexamic acid should be administered as soon as abnormal bleeding is recognised. Fibrinogen concentrate rather than fresh frozen plasma should be administered to restore haemostasis where there is elevated risk of fibrinogen deficiency (e.g., in catastrophic bleeding or in cases of abruption or amniotic fluid embolism) as it is a more concentrated source of fibrinogen. Lastly, organisational considerations are equally as important as clinical interventions in the management of PPH and have the potential to improve patient outcomes.

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“…Type O blood has been shown in the trauma literature to be associated with lower rates of von Willebrand factor (VWF), but whether type O blood increases the risk of PPH has not been confirmed, particularly for patients whose pregnancy is also complicated by thrombocytopenia. In a multicenter cohort study of 188 patients, 32 consecutive patients delivering with moderate or severe thrombocytopenia or immune thrombocytopenia purpura (mean platelet count, 90 000) were matched by age, mode of delivery, and ethnicity to controls with normal platelet counts. The authors found in their primary analysis that the adjusted risk of PPH associated with type O blood was stronger in patients with thrombocytopenia (aOR, 12.7; 95% CI, 2.9-55.3) than in patients without thrombocytopenia (aOR, 3.2; 95% CI, 1.1-9.5).…”

Section: Pertaining To Disparities In Hemorrhage By Conditionmentioning

confidence: 99%

Disparities in obstetric hemorrhage outcomes

James

Federspiel

Ahmadzia

2022

Research and Practice in Thrombosis and Haemostasis

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Both the maternal and fetal outcomes of pregnancy vary greatly according to a pregnant woman’s community and her condition. The most devastating outcome is the death of a mother. In 2017, there were ≈295,000 maternal deaths globally with dramatic differences in maternal mortality based on geographic region, country, and women’s underlying conditions. Worldwide, the leading cause of maternal death is hemorrhage, comprising 94% of maternal deaths, with most cases occurring in low‐ or middle‐income countries. Whether a hemorrhage originates from inside the uterus (80%‐90%), from lacerations or incisions (10%‐20%), or from an underlying coagulopathy (<1%), an acute acquired coagulopathy will evolve unless the hemorrhage is controlled. In low‐ or middle‐income countries, the full range of resources to control hemorrhage is not available, but besides the usual obstetric measures, blood availability, hemostatic medication, and hematologic expertise are necessary to save mothers’ lives. Hemostasis and thrombosis experts can address the disparities in obstetric hemorrhage outcomes not only as providers but as consultants, researchers, and advocates.

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Assessment of post‐partum haemorrhage risk among women with moderate thrombocytopenia

Cited by 7 publications

References 25 publications

Risk factors for postpartum hemorrhage in twin pregnancies with cesarean section

Risk factors for postpartum hemorrhage in twin pregnancies with cesarean section

Haemostatic support in postpartum haemorrhage

Disparities in obstetric hemorrhage outcomes

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