Postpartum haemorrhage in nulliparous women: incidence and risk factors in low and high risk women

Bais, Joke; Eskes, Martine; Pel, Maria; Bonsel, Gouke J.; Bleker, O. P.

doi:10.1016/j.ejogrb.2003.12.008

Cited by 63 publications

(38 citation statements)

References 22 publications

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“…The relevance of our finding that increasing birthweight is associated with risk of PPH is that we have shown that the relationship is dose dependent and that there is not a cut off at which increased risk occurs, for example with macrosomic or large for gestational age infants, which has been reported previously [44,45]. Contextualising this finding to the clinical setting, there is a 40% increase in risk for PPH with every 500g increase in birthweight in term infants.…”

Section: Discussionsupporting

confidence: 80%

Maternal obesity and postpartum haemorrhage after vaginal and caesarean delivery among nulliparous women at term: a retrospective cohort study

Fyfe

Thompson

Anderson

et al. 2012

BMC Pregnancy Childbirth

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BackgroundIncreasing rates of postpartum haemorrhage in developed countries over the past two decades are not explained by corresponding changes in risk factors and conjecture has been raised that maternal obesity may be responsible. Few studies investigating risk factors for PPH have included BMI or investigated PPH risk among nulliparous women. The aim of this study was to determine in a cohort of nulliparous women delivering at term whether overweight and obesity are independent risk factors for major postpartum haemorrhage (PPH ≥1000ml) after vaginal and caesarean section delivery.MethodsThe study population was nulliparous singleton pregnancies delivered at term at National Women’s Hospital, Auckland, New Zealand from 2006 to 2009 (N=11,363). Multivariable logistic regression was adjusted for risk factors for major PPH.ResultsThere were 7238 (63.7%) women of normal BMI, 2631 (23.2%) overweight and 1494 (13.1%) obese. Overall, PPH rates were increased in overweight and obese compared with normal-weight women (n=255 [9.7%], n=233 [15.6%]), n=524 [7.2%], p <.001) respectively. There was an approximate twofold increase in risk in obese nulliparous women that was independent of confounders, adjusted odds ratio [aOR (95% CI)] for all deliveries 1.86 (1.51-2.28). Being obese was a risk factor for major PPH following both caesarean 1.73 (1.32-2.28) and vaginal delivery 2.11 (1.54-2.89) and the latter risk was similar after exclusion of women with major perineal trauma and retained placentae. Three additional factors were consistently associated with risk for major PPH regardless of mode of delivery: increasing infant birthweight, antepartum haemorrhage and Asian ethnicity.ConclusionNulliparous obese women have a twofold increase in risk of major PPH compared to women with normal BMI regardless of mode of delivery. Higher rates of PPH among obese women are not attributable to their higher rates of caesarean delivery. Obesity is an important high risk factor for PPH, and the risk following vaginal delivery is emphasised. We recommend in addition to standard practice of active management of third stage of labour, there should be increased vigilance and preparation for PPH management in obese women.

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Section: Discussionsupporting

confidence: 80%

Maternal obesity and postpartum haemorrhage after vaginal and caesarean delivery among nulliparous women at term: a retrospective cohort study

Fyfe

Thompson

Anderson

et al. 2012

BMC Pregnancy Childbirth

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“…Secondary PPH is defined as any abnormal bleeding 24 hours to six weeks postpartum, regardless of volume. In high-resource countries where uterotonic drugs are used routinely, the reported incidence of primary PPH, severe primary PPH and secondary PPH is respectively 5–19%[12–14], 4–10% [13, 15, 16] and 1–3% [17]. …”

Section: Introductionmentioning

confidence: 99%

Postpartum Hemorrhage in Women with Von Willebrand Disease – A Retrospective Observational Study

et al. 2016

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Introductionvon Willebrand disease (VWD) is a hereditary bleeding disorder, caused by a deficiency in the levels and/or function of von Willebrand factor (VWF). Women with VWD appear to be at increased risk of experiencing postpartum hemorrhage (PPH), though the levels of VWF increase during pregnancy. There is limited knowledge of how PPH is associated with the subtype of VWD, plasma levels of other coagulations factors than VWF and given hemostatic treatment.AimsThe aims were to investigate the incidence of PPH in women with VWD and to analyse the correlation between PPH and: (1) type of VWD, (2) laboratory monitoring of VWF and FVIII and (3) hemostatic drug treatment.MethodsThis was a retrospective observational study. The study participants (n = 34) were recruited from the Coagulation Unit, Karolinska University hospital. Fifty-nine deliveries, which occurred in 14 different obstetrics units (years 1995–2012) were included in the study.ResultsThe incidence of primary PPH was 44%, severe primary PPH 20% and secondary PPH 12%. VWD type 3 was associated with a higher risk of experiencing severe primary PPH compared to other subtypes. FVIII:C in pregnancy was inversely correlated to blood loss during delivery. There was a significantly higher incidence of secondary PPH when the VWD diagnosis was unknown at time of delivery.ConclusionsThe women with VWD are at higher risk of PPH, especially those with type 3 VWD or when diagnosis is unknown prior to delivery. Identification of pregnant women with undiagnosed VWD may be of importance in order to prevent PPH.

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“…Retained placenta may be one of the main causes of death due to hemorrhage in low income countries but its pathophysiology is largely unknown [2, 3]. …”

Section: Introductionmentioning

confidence: 99%

Oxidative stress and inflammation in retained placenta: a pilot study of protein and gene expression of GPX1 and NFκB

Endler¹,

Saltvedt²,

Eweida³

et al. 2016

BMC Pregnancy Childbirth

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BackgroundRetained placenta is associated with severe postpartum hemorrhage. Its etiology is unknown and its biochemistry has not been studied. We aimed to assess whether levels of the antioxidative enzyme Glutathione Peroxidase 1 (GPX1) and the transcription factor Nuclear Factor κβ (NFκβ), as markers of oxidative stress and inflammation, were affected in retained placentas compared to spontaneously released placentas from otherwise normal full term pregnancies.MethodsIn a pilot study we assessed concentrations of GPX1 by ELISA and gene (mRNA) expression of GPX1, NFκβ and its inhibitor Iκβα, by quantitative real-time-PCR in periumbilical and peripheral samples from retained (n = 29) and non-retained (n = 31) placental tissue.ResultsMedian periumbilical GPX1 concentrations were 13.32 ng/ml in retained placentas and 17.96 ng/ml in non-retained placentas (p = 0.22), peripheral concentrations were 13.27 ng/ml and 19.09 ng/ml (p = 0.08). Retained placental tissue was more likely to have a low GPX1 protein concentration (OR 3.82, p = 0.02 for periumbilical and OR 3.95, p = 0.02 for peripheral samples). Median periumbilical GPX1 gene expressions were 1.13 for retained placentas and 0.88 for non-retained placentas (p = 0.08), peripheral expression was 1.32 and 1.18 (p = 0.46). Gene expressions of NFκβ and Iκβα were not significantly different between retained and non-retained placental tissue.ConclusionsWomen with retained placenta were more likely to have a low level of GPX1 protein concentration in placental tissue compared to women without retained placenta and retained placental tissue showed a tendency of lower median concentrations of GPX1 protein expression. This may indicate decreased antioxidative capacity as a component in this disorder but requires a larger sample to corroborate results.

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Postpartum haemorrhage in nulliparous women: incidence and risk factors in low and high risk women

Cited by 63 publications

References 22 publications

Maternal obesity and postpartum haemorrhage after vaginal and caesarean delivery among nulliparous women at term: a retrospective cohort study

Maternal obesity and postpartum haemorrhage after vaginal and caesarean delivery among nulliparous women at term: a retrospective cohort study

Postpartum Hemorrhage in Women with Von Willebrand Disease – A Retrospective Observational Study

Oxidative stress and inflammation in retained placenta: a pilot study of protein and gene expression of GPX1 and NFκB

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