Epidemiology and definition of PPH worldwide

Bláha, J; Bartošová, Tereza

doi:10.1016/j.bpa.2022.11.001

Cited by 22 publications

(15 citation statements)

References 127 publications

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“…PPH incidence estimates were similar (ranging 5.08%-7.61%) for WHO-conformant and non-conformant anemia definition groups, and fell within the worldwide reported incidence rates of 1% to 10%. 72 In addition to anemia, incidence rates are influenced by many factors such as PPH definition, delivery pratices, blood loss assessment methodology, and other locoregional risk factors.…”

Section: Discussionmentioning

confidence: 99%

Prepartum Anemia and Risk of Postpartum Hemorrhage: A Meta-Analysis and Brief Review

Glonnegger,

Glenzer,

Lancaster

et al. 2023

Clin Appl Thromb Hemost

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Postpartum hemorrhage (PPH) is responsible for 30% to 50% of maternal deaths. There is conflicting evidence if prepartum anemia facilitates PPH. A comprehensive analysis of studies describing their relation is missing. An extensive database search was conducted applying the terms “anemia” OR “hemoglobin” AND “postpartum hemorrhage.” We used a random-effects meta-analysis model to estimate an overall odds ratio (OR) for PPH and prepartum anemia, separating studies that were conformant and non-conformant with the World Health Organization (WHO) definitions for anemia. The search yielded 2519 studies, and 46 were appropriate for analysis. The meta-analyses of WHO-conformant ( n = 22) and non-conformant ( n = 24) studies showed that the risk of PPH was increased when anemia was present. The ORs were 1.45 (CL: 1.23-1.71) for WHO-conformant studies, 2.88 (CL: 1.38-6.02) for studies applying lower thresholds for anemia, and 3.28 (CL: 2.08-5.19) for undefined anemia thresholds. PPH risk appeared to increase with lower anemia thresholds. Prepartum anemia is associated with an increased risk of PPH, an observation that is important regarding improved anemia correction strategies such as iron supplementation.

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Section: Discussionmentioning

confidence: 99%

Prepartum Anemia and Risk of Postpartum Hemorrhage: A Meta-Analysis and Brief Review

Glonnegger,

Glenzer,

Lancaster

et al. 2023

Clin Appl Thromb Hemost

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“…The general prevalence of PPH, irrespective of the delivery method, lies between 2.9% and 3.2% [ 6 , 7 ], whereas in cesarean deliveries, the rate is approximately 0.4% to 5.1% [ 6 , 8 , 9 ]. The reported worldwide prevalence can reach as high as 10% [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Perioperative outcomes and causes of postpartum hemorrhage in patients undergoing cesarean delivery in Thailand: A comprehensive retrospective study

Nivatpumin,

Nithi-Uthai,

Lertbunnaphong

et al. 2024

PLoS ONE

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Background This study aimed to identify the characteristics, causes, perioperative anesthetic, and obstetric outcomes of patients experiencing postpartum hemorrhage (PPH) after cesarean delivery. Methods We retrospectively analyzed patients who underwent cesarean delivery at the largest university hospital in Bangkok, Thailand, during a 5-year period (January 1, 2016–December 31, 2020). PPH was defined as an estimated blood loss (EBL) of ≥ 1000 ml within 24 hours postpartum. Results Of 17 187 cesarean deliveries during the study period, 649 patients were included for analysis. The mean EBL was 1774.3 ± 1564.4 ml (range: 1000–26 000 ml). Among the patients, 166 (25.6%) experienced massive PPH (blood loss > 2000 ml). Intraoperative blood transfusions were necessary for 264 patients (40.7%), while 504 individuals (77.7%) needed intraoperative vasopressors. The analysis revealed uterine atony as the leading cause of PPH in 62.7% (n = 407) of the patients, with abnormal placentation following at 29.3% (n = 190). Abnormal placentation was associated with a significantly higher mean EBL of 2345.0 ± 2303.9 ml compared to uterine atony, which had a mean EBL of 1504.0 ± 820.7 ml (P < 0.001). Abnormal placentation also significantly increased the likelihood of blood transfusions and hysterectomies (P < 0.001 for both) and led to more intensive care unit admissions (P = 0.032). The risk of EBL exceeding 2000 ml was markedly higher in patients with abnormal placentation (odds ratio [OR] 5.12, 95% confidence interval [CI] 3.45–7.57, P < 0.001) and in cases involving trauma to the internal organs (OR 2.33, 95% CI 1.16–4.71, P = 0.018) than in patients with uterine atony. The study documented three instances of perioperative cardiac arrest, one of which was fatal. Conclusions These findings highlight the importance of comprehensive perioperative management strategies, including the ready availability of adequate blood and blood products, particularly in scenarios predisposed to significant hemorrhage. Trial registration Clinical trial registration: Clinicaltrial.gov registration number NCT04833556 (April 6, 2021).

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“…The World Health Organization adopted the criteria in 2013 and recommended these cut-off values as a reference standard for the diagnosis of gestational diabetes mellitus at any time in pregnancy. 5 Earlier detection of gestational diabetes mellitus could potentially improve short term neonatal outcomes (eg, infants born large for gestational age, defined as birth weight >90th centile) 6 or maternal complications (eg, caesarean section, 7 shoulder dystocia, 8 and haemorrhage 9 ). The International Federation of Gynaecology and Obstetrics (FIGO) recommends universal screening for diabetes and gestational diabetes mellitus.…”

Section: Introductionmentioning

confidence: 99%

Sensitivity, specificity, and diagnostic accuracy of WHO 2013 criteria for diagnosis of gestational diabetes mellitus in low risk early pregnancies: international, prospective, multicentre cohort study

Huhn,

Göbl,

Fischer

et al. 2023

bmjmed

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ObjectiveTo evaluate the predictability of gestational diabetes mellitus wth a 75 g oral glucose tolerance test (OGTT) in early pregnancy, based on the 2013 criteria of the World Health Organization, and to test newly proposed cut-off values.DesignInternational, prospective, multicentre cohort study.SettingSix university or cantonal departments in Austria, Germany, and Switzerland, from 1 May 2016 to 31 January 2019.ParticipantsLow risk cohort of 829 participants aged 18-45 years with singleton pregnancies attending first trimester screening and consenting to have an early 75 g OGTT at 12-15 weeks of gestation. Participants and healthcare providers were blinded to the results.Main outcome measuresFasting, one hour, and two hour plasma glucose concentrations after an early 75 g OGTT (12-15 weeks of gestation) and a late 75 g OGTT (24-28 weeks of gestation).ResultsOf 636 participants, 74 (12%) developed gestational diabetes mellitus, according to World Health Organization 2013 criteria, at 24-28 weeks of gestation. Applying WHO 2013 criteria to the early OGTT with at least one abnormal value gave a low sensitivity of 0.35 (95% confidence interval 0.24 to 0.47), high specificity of 0.96 (0.95 to 0.98), positive predictive value of 0.57 (0.41 to 0.71), negative predictive value of 0.92 (0.89 to 0.94), positive likelihood ratio of 10.46 (6.21 to 17.63), negative likelihood ratio of 0.65 (0.55 to 0.78), and diagnostic odds ratio of 15.98 (8.38 to 30.47). Lowering the postload glucose values (75 g OGTT cut-off values of 5.1, 8.9, and 7.8 mmol/L) improved the detection rate (53%, 95% confidence interval 41% to 64%) and negative predictive value (0.94, 0.91 to 0.95), but decreased the specificity (0.91, 0.88 to 0.93) and positive predictive value (0.42, 0.32 to 0.53) at a false positive rate of 9% (positive likelihood ratio 5.59, 4.0 to 7.81; negative likelihood ratio 0.64, 0.52 to 0.77; and diagnostic odds ratio 10.07, 6.26 to 18.31).ConclusionsThe results of this prospective low risk cohort study indicated that the 75 g OGTT as a screening tool in early pregnancy is not sensitive enough when applying WHO 2013 criteria. Postload glucose values were higher in early pregnancy complicated by diabetes in pregnancy. Lowering the postload cut-off values identified a high risk group for later development of gestational diabetes mellitus or those who might benefit from earlier treatment. Results from randomised controlled trials showing a beneficial effect of early intervention are unclear.Trial registrationClinicalTrials.govNCT02035059.

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Epidemiology and definition of PPH worldwide

Cited by 22 publications

References 127 publications

Prepartum Anemia and Risk of Postpartum Hemorrhage: A Meta-Analysis and Brief Review

Prepartum Anemia and Risk of Postpartum Hemorrhage: A Meta-Analysis and Brief Review

Perioperative outcomes and causes of postpartum hemorrhage in patients undergoing cesarean delivery in Thailand: A comprehensive retrospective study

Sensitivity, specificity, and diagnostic accuracy of WHO 2013 criteria for diagnosis of gestational diabetes mellitus in low risk early pregnancies: international, prospective, multicentre cohort study

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