The Impact of Obesity on the Management and Outcomes of Postpartum Hemorrhage

Abstract

Objective The study aimed to evaluate the impact of obesity on the management and outcomes of postpartum hemorrhage. Study Design We conducted a retrospective cohort study of women who delivered at a tertiary care center between February 1, 2013 and January 31, 2014 and experienced a postpartum hemorrhage. Charts were reviewed for clinical and sociodemographic data, and women were excluded if the medical record was incomplete. Hemorrhage-related severe morbidity indicators included blood transfusion, shock, renal failure, transfusion-related lung injury, cardiac arrest, and use of interventional radiology procedures. Obese (body mass index [BMI] ≥ 30 kg/m2) and nonobese women were compared. Data were analyzed using Chi-square, Student's t-test, Mann–Whitney U test, and linear regression where appropriate. The p-value <0.05 was significant. Results Of 9,890 deliveries, 2.6% (n = 262) were complicated by hemorrhage. Obese women were more likely to deliver by cesarean section (55.5 vs. 39.8%, p = 0.016), undergo a cesarean after labor (31.1 vs. 12.2%, p = 0.001), and have a higher quantitative blood loss (1,313 vs. 1,056 mL, p = 0.003). Both groups were equally likely to receive carboprost, methylergonovine, and misoprostol, but obese women were more likely to receive any uterotonic agent (95.7 vs. 88.9%, p = 0.007) and be moved to the operating room (32.3 vs. 20.4, p = 0.04). There was no difference in the use of intrauterine pressure balloon tamponade, interventional radiology, or decision to proceed with hysterectomy. The two groups were similar in time to stabilization. There was no difference in the need for blood transfusion. Obese women required more units of blood transfused (2.2 ± 2 vs. 2 ± 5 units, p = 0.023), were more likely to have any hemorrhage-related severe morbidity (34.1 vs. 25%, p = 0.016), and more than one hemorrhage related morbidity (17.1 vs. 7.9, p = 0.02). After controlling for confounding variables, quantitative blood loss, and not BMI was predictive of the need for transfusion. Conclusion Despite similar management, obese women were more likely to have severe morbidity and need more units of blood transfused. Key Points

Development of antepartum risk prediction model for postpartum hemorrhage in Lagos, Nigeria: A prospective cohort study (Predict‐PPH study)

“…39 The observed link between obesity and PPH, as reported in our study, has been attributed to the increased risk of cesarean section and the impaired uterine response to control bleeding due to the possible disruption of the hormonal balance in obese women. 40 Similar to our study, previous studies have reported that women with a previous history of PPH have up to three-fold higher risk of PPH. 41,42 This could be explained by the presence of chronic comorbidities that are known risk factors for PPH, such as hypertensive disorders in pregnancy and uterine fibroids or genetic or environmental factors that affect the risk of PPH throughout pregnancy.…”

Impact of body weight on the outcome of pregnancy

“… 19 Another study suggest that obese women had higher quantities of blood loss, required more transfused blood units and had more severe morbidity although they had the same management as those with normal BMI. 20 …”

“…19 Another study suggest that obese women had higher quantities of blood loss, required more transfused blood units and had more severe morbidity although they had the same management as those with normal BMI. 20 However, debate is still ongoing on other such outcomes resulting from pre-pregnancy obesity or obesity occurring throughout pregnancy. Studies described how obesity might predispose for maternal and fetal illnesses either before or during pregnancy.…”

Predictive analysis of maternal subcutaneous fat thickness for the risk of postpartum haemorrhage

“…In Present study PPH was more common in women with LSCS (69.2%) compared to vaginal delivery (30.8%) which is in contrast with the observation made by Blomberg M [8] and Usha Kiran TS et al [22] where a small increased risk among obese women following vaginal delivery was observed. Polic A et al in their study observed that obese women were more likely to deliver by cesarean section (55.5 vs. 39.8%, p = 0.016) and were more likely to have a higher quantitative blood loss and require more units of blood transfusion and had more severe morbidity although they had the same management as those with normal BMI [23].…”