Prediction of Hemorrhage at Cesarean Delivery

Naef, Robert W.; Chauhan, Suneet P.; Chevalier, Steven P.; Roberts, William S.; Meydrech, Edward F.; Morrison, John C.

doi:10.1097/00006250-199406000-00004

Cited by 67 publications

(50 citation statements)

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“…Postpartum hemorrhage associated with obesity was described by Bowers & Cohen 4 and with greater weight gain by Magann et al 10 The study data showed no such risk for obesity and as such are inconsistent with Naef et al 14 findings, which characterized obesity as a risk factor. Moreover, it was found no previous reports stratifying risk of hemorrhage by route of delivery and reporting that the association of hemorrhage with greater weight gain is restricted to those with vaginal delivery.…”

Section: Discussionmentioning

confidence: 85%

Obesity and gestational weight gain: cesarean delivery and labor complications

et al. 2006

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OBJECTIVE:To assess the association between pre-gestational obesity and weight gain with cesarean delivery and labor complications. METHODS:A total of 4,486 women 20-28 weeks pregnant attending general prenatal care clinics of the national health system in Brazil from 1991 to 1995 were enrolled and followed up through birth. Body mass index categories based on prepregnancy weight and total weight gain were calculated. Associations between body mass index categories and labor complications were adjusted through logistic regression analysis. RESULTS:Obesity was present in 308 (6.9%) patients. Cesarean delivery was performed in 164 (53.2%) obese, 407 (43.1%) pre-obese, 1,045 (35.1%) normal weight and 64 (24.5%) underweight women. The relative risk for cesarean delivery in obese women was 1.8 (95% CI: 1.5-2.0) compared to normal weight women. Greater weight gain was particularly associated with cesarean among the obese (RR 4 th vs 2 nd weight gain quartile 2.2; 95% CI: 1.4-3.2). Increased weight at the beginning of pregnancy was associated with a significantly higher adjusted risk of meconium with vaginal delivery and perinatal death and infection in women submitted to cesarean section. Similarly, greater weight gain during pregnancy increased the risk for meconium and hemorrhage in women submitted to vaginal delivery and for prematurity with cesarean. CONCLUSIONS:Pre-gestational obesity and greater weight gain independently increase the risk of cesarean delivery, as well as of several adverse outcomes with vaginal delivery. These findings provide further evidence of the negative effects of prepregnancy obesity and greater gestational weight gain on pregnancy outcomes. INTRODUCTIONThe prevalence of overweight and obesity have substantially increased in the last decades, especially in women. Data from 1989 reported that 13.3% of Brazilian women were obese and a national survey conducted in 1996 showed that 10.2% of Brazilian women of reproductive age (20 to 49 years) were obese. Additionally the prevalence of overweight among Brazilian women in this age group was 36.8% in 1996. 13Medical complications such as diabetes and hypertension are significantly increased during pregnancy in obese patients. Fetal distress, meconium staining, arrest disorders, hemorrhage, difficult peridural access and operatory time are also increased in obese women. Furthermore, evidence of increased risk for cesarean section, endometritis, prolonged hospital stay, thromboembolic phenomena, anemia, urinary tract infection, prematurity and fetal demise have been described. 23Cesarean sections (C-sections) have become more frequent since 1970-80 around the world. Between 1965 and 1986, the rate of cesarean delivery in the United States increased from 4.5 to 24.1%. 21 From 1984 to1993, cesarean delivery was the most frequent major surgical procedure in the United States. Rates then declined slightly to 20.7% in 1996 and, more recently increased again in 2002 reaching 26.1%, the highest rate ever recorded.12 In a city of southern Brazi...

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Section: Discussionmentioning

confidence: 85%

Obesity and gestational weight gain: cesarean delivery and labor complications

et al. 2006

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“…Obstetric haemorrhage can occur in association with operative abdominal delivery 3 . In a recent investigation at our institution, we discovered that 8% of our caesarean deliveries are accompanied by blood loss in excess of 1500mL and/or a drop in the haematocrit of 10% 4 . Several techniques have been proposed to reduce blood loss at operative abdominal delivery, including placental management (spontaneous compared with manual extraction) and in situ uterine incision repair compared with exteriorisation 5 -7 .…”

Section: Introductionmentioning

confidence: 94%

Intra-operative haemorrhage by blunt versus sharp expansion of the uterine incision at caesarean delivery: a randomised clinical trial

Magann¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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Objective To determine whether the method used to expand the uterine incision for caesarean delivery affects the incidence of intra-operative haemorrhage. Design A prospective randomised study of women undergoing a low segment transverse caesarean delivery.Participants were assigned to have their uterine incision either sharply or bluntly expanded. Participants Between June 1998 and June 2000, 470 women drew assignments to the sharp expansion group and 475 to the blunt group. Results The maternal demographics of age, race, nulliparity, and body mass index as well as pre-operative haematocrit were similar between groups. Compared with the blunt group, the estimated blood loss (886 versus 843mL, P ¼ 0.001), change in the mean haematocrit (6.1% versus 5.5%, P ¼ 0.003), incidence of postpartum haemorrhage (13% versus 9%; relative risk ¼ 1.23, 95% CI 1.03, 1.46) and need for a transfusion (2% versus 0.4%; relative risk ¼ 1.65, 95% CI 1.25, 2.21) were significantly greater in the sharp group. Conclusion In caesarean delivery, sharply expanding the uterine incision significantly increases intra-operative blood loss and the need for subsequent transfusion.

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“…Depending on the severity of blood loss anaemic patients may present an increased morbidity, including cardiovascular symptoms, dizziness, fatigue, infections and lactation problems [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Use of recombinant human erythropoietin in combination with parenteral iron in the treatment of postpartum anaemia

Breymann

Zimmermann

Huch

et al. 1996

Eur J Clin Investigation

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Abstract. The authors compared the effect of recombinant human erythropoietin (rhEPO) in combination with iron with that of iron therapy only in the treatment of postpartum anaemia. Ninety patients (30 patients/ group) received either rhEPO (300 U kg ÿ 1 , i.v. or s.c., once) and iron (parenteral and oral), or iron therapy only. Erythropoiesis was assessed by haemoglobin and haematocrit increase, absolute reticulocyte counting and reticulocyte flow cytometry. Ferrokinetics was assessed by serum ferritin, transferrin and transferrin saturation measurements. There was no difference before therapy for baseline haematological values or iron status. Patients with endogenous EPO levels below 145 mU mL ÿ 1 had a significant benefit from intravenous rhEPO administration with highest haematocrit and haemoglobin levels 4 and 14 days after therapy. rhEPO-treated groups showed a higher absolute reticulocyte count 1 and 4 days after therapy and an elevated percentage of high fluorescent reticulocytes (HFRs). Parenteral iron therapy caused a significant increase of ferritin and transferrin saturation, while transferrin concentration decreased. Ferritin and transferrin levels were lowest after i.v. administration of rhEPO, 1 and 4 days after therapy. C-reactive protein concentration was highest in patients who underwent caesarean section until the end of the observation period. A single dose of rhEPO in combination with iron was more effective in treating postpartum anaemia than iron therapy only, in patients who had low EPO levels despite peripartal blood loss. Postpartum low endogenous EPO levels might be a consequence of inhibiting inflammatory cytokines that are released after spontaneous or operative deliveries.

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Prediction of Hemorrhage at Cesarean Delivery

Cited by 67 publications

References 0 publications

Obesity and gestational weight gain: cesarean delivery and labor complications

Obesity and gestational weight gain: cesarean delivery and labor complications

Intra-operative haemorrhage by blunt versus sharp expansion of the uterine incision at caesarean delivery: a randomised clinical trial

Use of recombinant human erythropoietin in combination with parenteral iron in the treatment of postpartum anaemia

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