Is hiesho in pregnant women a risk factor for postpartum haemorrhage?

Abstract

Background: In Japanese culture, a cold sensation known as "hie" is an important symptom in traditional medicine. Hiesho is a condition whereby the sympathetic nervous system becomes dominant, causing peripheral blood vessels to contract, impairing circulation and leading to low skin temperatures in the extremities. A link between hiesho and prolonged labour and uterine inertia, both of which are risk factors for postpartum haemorrhage (PPH), has previously been identified. Aim: The aim of this study was to analyse whether hiesho has a direct impact on PPH by comparing the outcomes for women who experienced hiesho in their pregnancies with those who did not. Methods: The study design was a retrospective cohort study conducted over 12 months, between 19th October, 2009, and 8th October, 2010, involving 2,427 women who had given birth in six hospitals in Japan. Women were excluded if they had had a caesarean section. Data were extracted from medical records and a paper questionnaire. Analysis was conducted using multiple logistic regression analysis and the Mantel-Haenszel test. Findings: Of the women, 613 experienced PPH (25.3% of the entire sample), of whom 343 (56.0%) had experienced hiesho. In the analysis of covariance, the regression coefficient for hiesho was 0.2, p=0.07, the odds ratio (OR) was 1.22, and the 95% confidence interval (CI) was 0.98-1.50. In a stratified analysis, the regression coefficient was 0.25, p=0.02, the common OR was 1.29, and 95% CI was 1.04-1.59. Thus, there was no significant link found between a woman experiencing heisho during pregnancy and having a PPH. Conclusion: Although the findings indicate that uterine inertia and prolonged labour are direct causes of PPH, hiesho may potentially have an indirect effect. Therefore, since hiesho potentially affects the occurrence of uterine inertia and prolonged labour, preventing hiesho may help avoid uterine inertia and prolonged labour and consequently PPH. For women who experience hiesho in pregnancy, lifestyle activities known to improve peripheral circulation should be promoted antenatally.

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“…The proportion of participants with symptoms of sensitivity to cold was low (23.9%) in this study compared with the reported prevalence of >50% [ 41 ]. Sensitivity to cold may indirectly affect uterine inertia and prolong labor, which are known risk factors for postpartum hemorrhage and associated birth problems [ 12 ]. The participants in this study are likely to be healthier than the general population because of the recruitment of almost all participants through local clinics [ 28 ].…”

“…Anemia is a common health and nutritional problem worldwide, and women are particularly prone to anemia during menstruation, pregnancy, and childbirth. Sensitivity to cold is a clinical symptom in traditional oriental medicine, known as the common phenotype of “hiesho” in Japanese [ 11 , 12 ]. Sensitivity to cold is prevalent in >50% of Japanese women [ 11 ] and is a possible risk factor for birth complications such as uterine inertia, prolonged labor, and postpartum hemorrhage [ 12 ].…”

“…Sensitivity to cold is a clinical symptom in traditional oriental medicine, known as the common phenotype of “hiesho” in Japanese [ 11 , 12 ]. Sensitivity to cold is prevalent in >50% of Japanese women [ 11 ] and is a possible risk factor for birth complications such as uterine inertia, prolonged labor, and postpartum hemorrhage [ 12 ]. The skin is among the tissues affected by the complex endocrinologic, immunologic, and metabolic changes during pregnancy [ 13 ], and rough skin is one of the most common postpartum concerns [ 14 ].…”