Body Mass Index and Severe Postpartum Hemorrhage

Abstract

Background/Aims: The purpose of this study was to determine the relationship between maternal characteristics and severe postpartum hemorrhage (PPH). Methods: Medical records of women who delivered at Duke University Hospital between 2001 and 2004 with an ICD-9 code for PPH were reviewed. Women with PPH who received blood component therapy (severe PPH) were selected as cases and compared with controls matched for age, parity and mode of delivery. Results: Among 12,476 deliveries, there were 109 women with severe PPH. Hispanic women had an almost fourfold increase in the odds of severe PPH [OR 3.9 (1.8, 8.7)] that persisted when controlling for other significant predictors of PPH. Women with PPH were almost two times more likely [OR 1.8 (1.1, 3.1)] to have a BMI <30 when controlling for Hispanic ethnicity, oxytocin exposure, labor induction, treatment with magnesium and chorioamnionitis. Conclusion: Systemic factors as well as obstetrical factors modify the risk of severe PPH. Hispanic women and women with a BMI <30 are more likely to have severe PPH. When mode of delivery is controlled for, BMI ≧30 is associated with a reduced risk of severe PPH.

Reporting errors, incidence and risk factors for postpartum haemorrhage and progression to severe PPH: a prospective observational study

“…No previous study has specifically identified Black African ethnicity as an independent predictor,16–19,48 possibly because of lack of adjustment for potential confounding variables 49–52. The independent relationship between BMI and PPH concurs with prospective cohort studies,14,53 although retrospective and routine data reports are equivocal 54–56. The 4% increase per BMI unit becomes substantial in higher obesity categories.…”

Pre-Eclampsia Increases the Risk of Postpartum Haemorrhage: A Nationwide Cohort Study in The Netherlands

“…[8], [11], [19], [53] However the role of body mass index on PPH is not clear yet. [54] Another possible and not registered confounder is magnesium sulphate, since it could, hypothetically, increase blood loss by vasodilatation, a tocolytic effect predisposing to uterine atony, prolonged bleeding time through platelet activity inhibition and red cell deformity and it is used in the Netherlands for the management of (pre-) eclampsia (as prevention in severe PE women (defined as blood pressure ≥110 mmHg diastolic or ≥110 mmHg systolic or proteinuria ≥5 grams or the presence of symptoms prognostic for eclampsia) or as treatment in women with eclampsia). Rouse et al determined an increased risk for PPH in hypertensive disorders which disappeared after correction for magnesium sulphate.…”

Does skin-to-skin contact and breast feeding at birth affect the rate of primary postpartum haemorrhage: Results of a cohort study

“…Body Mass Index has been identified more recently as a possible cause of PPH (Fyfe et al, 2012); however, as with the traditionally accepted risk factors listed above, it may be that a raised BMI is not an independent risk factor when other confounding variables are controlled (Paglia et al, 2012).…”