Postpartum Blood Loss in COVID-19 Patients—Propensity Score Matched Analysis

Abstract

The aim of this study was to compare the estimated blood loss and the frequency of obstetric hemorrhage among pregnant women with and without COVID-19 infection. The study was carried out in the Department of Obstetrics and Gynecology, at the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Poland. From 15 May 2020 to 26 April 2021, a total of 224 parturients with COVID-19 infection were admitted for labor. The control group consisted of 300 randomly recruited pre-pandemic deliveries that took place between 15 May 2019 and 26 April 2020 at the Department. The primary outcome was the presence of postpartum hemorrhage, defined as an estimated blood loss of ≥500 mL within 24 h after birth or the need to transfuse 2 or more units of packed red blood cells (pRBCs). Secondary outcomes were the difference between hemoglobin and hematocrit levels at 24 h postpartum, the number of pRBCs units transfused, and the need for transperitoneal drainage. After applying the propensity-score-matching procedure for postpartum bleeding risk factors, 325 eligible patients were included in the final analysis, divided into 203 COVID-19 positive and 122 COVID-19 negative prepandemic deliveries. SARS-CoV-2 infected patients were characterized by a longer activated partial thromboplastin time (APTT), a reduced prothrombin time (PT), and lower platelet count at initial presentation. COVID-19 deliveries were found to be associated with a higher frequency of postpartum hemorrhage, an increased estimated blood loss, the more frequent use of peritoneal drainage, and more pRBCs units transfused. During the pandemic, an increased risk of postpartum hemorrhage posed another threat to SARS-CoV-2 infected pregnant women. It is essential to be aware of this when approaching COVID-19 delivery and to implement efficient preventative methods.

Case report: Complex evaluation of coagulation, fibrinolysis and inflammatory cytokines in a SARS-CoV-2 infected pregnant woman with fetal loss

“…The findings of hypofibrinogenaemia have been also described earlier in pregnancies with COVID-19, which differs vastly from the COVID-19 associated coagulopathy in non-pregnant individuals, where fibrinogen levels are usually within the reference range or even increased ( 23 ). Given the association between hypofibrinogenaemia and postpartum hemorrhage, awareness is needed when it comes to the management of SARS-CoV-2-infected pregnant women, even if they are asymptomatic or have only mild respiratory symptoms ( 24 , 25 ). Aside from our report, detailed analysis of coagulation and fibrinolysis has not been published in women with COVID-19 and intrauterine fetal loss, and the prognostic significance of these markers has not been evaluated.…”

COVID-19, maternal, and neonatal outcomes: National Mother-Child Cohort (NMCC) of K-COV-N cohort in South Korea

“…Furthermore, it is also speculated that COVID-19 infection with the Delta variant with relatively strong virulence levels might affect placental development and subclinical placental infection in mid-gestation. This can lead to disturbances to normal hemostasis after delivery, physiologically achieved by complete placental separation and uterine myometrial contraction that directly compresses the avulsed vessels on the implantation site, and can in turn lead to PPH [ 10 , 20 ]. In the third trimester, particularly towards the end of the pregnancy and close to birth, obstetricians or maternal-fetal-medicine specialists in most of the medical institutions in Korea favored timely Cesarean section to vaginal delivery in COVID-19 infected pregnant women to minimize transmission and as a result, the risk of PPH may be reduced [ 11 , 21 , 22 ].…”

“…Except for Janssen, we defined a mother to possess a complete vaccination status after the second vaccination. In the case of the COVID-19 group, a fully vaccinated mother was defined by a second vaccination undertaken prior to infection [ 10 , 11 ].…”

Managing Labour in Women with COVID-19

“…The risk of postpartum haemorrhage has been noted to be increased in women with COVID-19 [ 66 , 67 ], and precautions should be taken to minimise this [ 30 , 68 ]. This may be associated with other known complications, e.g., thrombocytopenia/DIC [ 66 , 67 ].…”