Association between birth weight and massive haemorrhage in pregnancy with a low-lying placenta: a 9-year single-centre retrospective cohort study in Japan

Abstract

A low-lying placenta is a well-known cause of a massive intrapartum haemorrhage. We aimed to evaluate whether neonatal birth weight deviation from the nationwide average could predict a massive haemorrhage during a delivery in the women with a low-lying placenta. This study included 40 women. The main outcomes were a massive haemorrhage and a neonatal birth weight deviation. We used a receiver operating characteristic curve analysis to determine the optimal birth weight deviation cut-off for predicting a massive haemorrhage. A multiple logistic regression model was used to identify the variables significantly associated with a massive haemorrhage. The best cut-off for predicting a massive haemorrhage was a birth weight deviation of +0.51 standard deviations (SDs) from the nationwide average. A birth weight deviation of ≥ +0.51 SDs was significantly associated with an increased massive haemorrhage risk. Impact statement What is already known on this subject? A low-lying placenta is a well-known cause of a massive intrapartum haemorrhage. Therefore, when managing pregnancies with a low-lying placenta, the possibility of severe perinatal bleeding should be considered, and it is desirable to determine reliable predictors of a haemorrhage. However, few studies have reported the predictive factors of a massive haemorrhage in patients with a low-lying placenta. What do the results of this study add? We demonstrated that a birth weight deviation from the nationwide average was significantly associated with a massive intrapartum haemorrhage in patients with a low-lying placenta. To our knowledge, this is the first study to clarify the association between a neonatal birth weight and a massive intrapartum haemorrhage incidence and to determine the optimal birth weight deviation cut-off for predicting a massive haemorrhage in patients with a low-lying placenta. What are the implications of these findings for clinical practice and/or further research? An accurate risk stratification using the foetal weight as a marker for a predicting massive intrapartum haemorrhage may help in the management of patients with a low-lying placenta. Studies with a larger sample size are required to confirm our findings.

Maternal death and postpartum hemorrhage in sub‐Saharan Africa – A pilot study in metropolitan Mozambique

“…In contrast to other studies originating from higher-developed parts of the world, [39][40][41][42] shorter gestation and lower fetal weight were also associated with a greater risk of PPH. It is possible that premature delivery and/or small infants were a surrogate for poor fetal/maternal health, rendering mothers more vulnerable to PPH.…”

Predicting postpartum haemorrhage: A systematic review of prognostic models

“…Two studies 35,39 described PPH as an estimated blood loss (EBL) of ≥500 mL, and one 37 as ≥600 mL after vaginal birth without describing how it was measured. Most of the studies that included women having a caesarean birth defined PPH as a blood loss ≥1000 mL, 31,42–44 and one defined it as ≥1500 mL within two hours from birth 46 . One study defined PPH as excessive postpartum blood loss defined as a reduction in Hb >3.5 g/dL up to 24 h post‐birth 33 .…”

“…Three studies included any mode of birth, 32,36,38 one of these limited their population to women with gestational hypertension or mild pre-eclampsia. 32 Seven studies included women with vaginal birth only; [33][34][35]37,[39][40][41] the remaining studies included women with caesarean birth, 31,[42][43][44][45][46]…”

“…The number of candidate predictors ranged 1-20 (Table 2). The types of selected variables included maternal demographics (such as maternal age, [31][32][33][34]37,39,41,[43][44][45] body mass index 32,33,39,42,43 and maternal weight, 41 race 44 and ethnicity 32,41 [one study specified only Asian ethnicity 42 ]); medical and obstetric history (such as parity, [32][33][34]36,37,[40][41][42][43][44] history of caesarean section, 31,36,42 diabetes, 38,39 hypertensive disorders [pre-existing 38 or developed during pregnancy 32,39,42 ]); results from investigations (laboratory, [31][32][33]35,37,40,41 ultrasound, 31,43,45,46 or magnetic...…”

“…Four studies 34,41,44,46 rated high risk of bias for using predictors that may not be available at the time the model is intended to be used (eg neonatal birthweight and placental weight). Peyvandi et al 35 relied on a predictor that was not assessed in the same way for all participants, therefore was also rated high risk of bias.…”