1
|
Jafarabady K, Eshraghi N, Zare F, Shokouhi N, Abbasi M, Mahdiyar P, Bakhtiyari M. Association of oxytocin augmentation with postpartum hemorrhage: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2024; 37:2369210. [PMID: 38910114 DOI: 10.1080/14767058.2024.2369210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/12/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE The current study aims to evaluate the correlation between oxytocin augmentation and postpartum hemorrhage. METHOD PubMed, Web of Science, and Scopus has been searched for studies assessing the correlation between oxytocin augmentation and postpartum hemorrhage up to January 24, 2024. The search strategy included relevant keywords related to PPH and oxytocin augmentation. The risk of bias assessment was conducted by two reviewers using the Newcastle-Ottawa Scale (NOS). To pool the effects sized of included studies odds ratios (OR) of interest outcome with their 95% confidence interval (CI) were used. RESULTS Eight studies were included in this meta-analysis. The pooled analysis of the included studies showed a statistically significant association between oxytocin augmentation and increased odds of PPH (pooled odds ratio [OR] = 1.27, 95% confidence interval [CI]: 1.05-1.53; I2 = 84.94%; p = 0.01). Publication bias was assessed using funnel plots, which appeared relatively asymmetrical, indicating significant publication bias. Galbraith plot and trim and fill plot were used for publication bias. Sensitivity analyses were performed by leave one out method. CONCLUSION This meta-analysis suggests that using oxytocin for labor augmentation is linked to a significant increase in the risk of PPH. It highlights the need for careful monitoring and consideration when using oxytocin, especially in low and middle-income countries where guidelines and supervision are crucial.
Collapse
Affiliation(s)
- Kyana Jafarabady
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Nasim Eshraghi
- Student Research Committee, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Zare
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Nasim Shokouhi
- Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Abbasi
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Pegah Mahdiyar
- Student Research Committee, School of Medicine, Azad University of Medical Sciences, Tehran, Iran
| | - Mahmood Bakhtiyari
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| |
Collapse
|
2
|
Abecassis A, Wainstock T, Sheiner E, Miodownik S, Pariente G. Risk factors for early postpartum hemorrhage: A retrospective, population-based, cohort analysis. Int J Gynaecol Obstet 2024; 166:812-818. [PMID: 38321817 DOI: 10.1002/ijgo.15414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To identify risk factors for developing early postpartum hemorrhage (PPH) and to examine whether risk factors vary according to severity and mode of delivery. METHODS A population-based cohort study was conducted in which all deliveries at a tertiary medical center were included. Risk factors for developing early PPH were compared based on the severity of bleeding as well as the mode of delivery. Multiple logistic regression models were used to control for confounders. RESULTS Among 322 497 deliveries included in the analysis, early PPH complicated 1811 (0.56%) of all deliveries. Among all cases of early PPH, 505 deliveries (28%) were complicated with severe PPH. Using a logistic regression model, in vitro fertilization (IVF) pregnancy, previous cesarean delivery (CD), pre-eclampsia, placental abruption, and uterine rupture were independently associated only with severe early PPH, while non-progressive second stage of labor, induction of labor, and large for gestational age were independently associated with both severe and mild early PPH. When applying an additional logistic regression model, whereas IVF pregnancy, pre-eclampsia, and large for gestational age were independently associated with early PPH among vaginal deliveries only, placenta previa was independently associated with early PPH among CD only. CONCLUSIONS Independent risk factors for developing severe PPH solely include IVF pregnancy, previous CD, pre-eclampsia, placental abruption, and uterine rupture. IVF pregnancy, pre-eclampsia, and large for gestational age are independent risk factors for early PPH following vaginal delivery, while placenta previa is independently associated with early PPH after CD only. Due to the recognition of the importance of both the provider and institutional planning and preparation for PPH, the study's results should be viewed within the scope of its retrospective cohort design.
Collapse
Affiliation(s)
- Avishag Abecassis
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shayna Miodownik
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
3
|
Yang WJ, Kang D, Sung JH, Song MG, Park H, Park T, Cho J, Seo TS, Oh SY. Association between uterine artery embolization for postpartum hemorrhage and second delivery on maternal and offspring outcomes: a nationwide cohort study. Hum Reprod Open 2024; 2024:hoae043. [PMID: 39036364 PMCID: PMC11259214 DOI: 10.1093/hropen/hoae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/11/2024] [Indexed: 07/23/2024] Open
Abstract
STUDY QUESTION What are the maternal and neonatal outcomes of second delivery in women who underwent uterine artery embolization (UAE) during their first delivery? SUMMARY ANSWER Women who underwent UAE during their first delivery exhibited higher risks of placental problems, preterm births, and postpartum hemorrhage (PPH) in second delivery and the second offspring also showed increased risk of major congenital malformations, admission to the neonatal intensive care units (NICU), necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia. WHAT IS KNOWN ALREADY UAE is a minimally invasive procedure used as an alternative to hysterectomy for managing severe PPH. However, recent studies have raised concerns about potential obstetric complications, including recurrent PPH, placenta accreta spectrum (PAS), and fetal growth restriction in subsequent delivery following UAE. STUDY DESIGN SIZE DURATION This was a nationwide retrospective cohort study using the Korean National Health Insurance Service (K-NHIS) database, covering 50 million individuals from 2004 to 2020. The cohort included 3 616 923 women with live births between 1 January 2005 and 31 December 2019 with follow-up data extending to 31 December 2020. PARTICIPANTS/MATERIALS SETTING METHODS The study included women who had their first live birth between 2005 and 2019, excluding those who underwent hysterectomy (without UAE = 3 612 389, UAE = 4534). Among them, we selected women who had single gestation secondary delivery (without UAE = 1 694 600, UAE = 1146). Propensity score matching was used to control for confounding factors, resulting in 11 184 women without UAE and 1119 women with UAE for subsequent analysis. MAIN RESULTS AND THE ROLE OF CHANCE Women in the UAE group had significantly higher risks of PAS (odds ratio (OR) = 38.91, 95% CI = 18.61-81.34), placenta previa (OR = 6.98, 95% CI = 5.57-8.75), and preterm birth (OR = 2.23, 95% CI = 1.71-2.90) during their second delivery. The risk of recurrent PPH was also significantly higher (OR = 8.94, 95% CI = 7.19-11.12). Their second offspring were more likely to have major congenital malformations (OR = 1.62, 95% CI = 1.25-2.11) and adverse neonatal outcomes, including NICU admissions (OR = 1.83, 95% CI = 1.48-2.25). Long-term outcomes showed a higher risk of attention-deficit/hyperactivity disorder (hazard ratio = 1.64, 95% CI = 1.03-2.63) but were otherwise comparable to those in the without UAE group. LIMITATIONS REASONS FOR CAUTION Retrospective nature of the study may have introduced exposure and outcome misclassifications, despite the reliability of the K-NHIS database. Unmeasured confounders and selection bias due to only including live births could also have influenced the results. WIDER IMPLICATIONS OF THE FINDINGS Women with a history of UAE require meticulous prenatal care and close monitoring during subsequent deliveries due to increased risks of complications. Counseling and referral to high-risk medical centers may improve outcomes. Further research is needed to understand the mechanisms of complications in both mothers and offspring at sequential delivery, as well as to refine UAE procedures. STUDY FUNDING/COMPETING INTERESTS This study supported by Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (HC21C0123). This study was funded by S.-Y.O. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Woo Jin Yang
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Ji-Hee Sung
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Gyu Song
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyejeong Park
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Taegyun Park
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Big Data Research and Development, National Health Insurance Service, Wonju, Republic of Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Tae-Seok Seo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
4
|
Gooijer K, Heidsieck G, Harsevoort A, Bout D, Janus G, Franken A. Bleeding assessment in a large cohort of patients with Osteogenesis Imperfecta. Orphanet J Rare Dis 2024; 19:61. [PMID: 38347577 PMCID: PMC10860322 DOI: 10.1186/s13023-024-03054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Osteogenesis Imperfecta (OI) is characterised by bone fragility. Among several features, easy bruising and multiple case reports on haemorrhagic events have been reported. This paper describes the diverse manifestations of bleeding and bruising in a large cohort of 328 OI patients. The aim of this study is to provide insight in the diverse aspects and therapeutic considerations of bleedings in OI. METHODS This descriptive cohort study was conducted at the National Expert Center for adults with OI in the Netherlands. Bleeding was assessed by the validated self-bleeding assessment tool (Self-BAT) The tool was distributed among 328 adults with different clinically confirmed types of OI. RESULTS 195 of 328 invited patients (completion rate 60%) with OI type 1 (n = 144), OI type 3 (n = 17) and OI type 4 (n = 34), aged between 18 and 82 years, completed the tool. Self-BAT scores were above the normal range in 42% of all patients. For males Self-BAT scores were increased in 37% with a mean score of 3.7, ranged between 0 and 18. For females the Self-BAT scores were increased in 44% with a mean of 5.4 and a range of 0-24. No statistical differences in OI subtypes were found. CONCLUSIONS Bleeding tendency appears to be a relevant complication in OI patients as this study confirms the presumption of bleeding tendency. There are specific recommendations to clinicians who treat OI patients to consider an assessment of bleeding tendency and use potential interventions to reduce haemorrhagic complications and improve quality of life.
Collapse
Affiliation(s)
- Koert Gooijer
- Expert Center for Adults with Osteogenesis Imperfecta, Isala Hospital, Dokter van Heesweg 2, PO Box 10400, 8025 AB, Zwolle, The Netherlands.
- Department of Clinical Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
| | - Gabriëla Heidsieck
- Expert Center for Adults with Osteogenesis Imperfecta, Isala Hospital, Dokter van Heesweg 2, PO Box 10400, 8025 AB, Zwolle, The Netherlands
| | - Arjan Harsevoort
- Expert Center for Adults with Osteogenesis Imperfecta, Isala Hospital, Dokter van Heesweg 2, PO Box 10400, 8025 AB, Zwolle, The Netherlands
| | - Daniëlle Bout
- Expert Center for Adults with Osteogenesis Imperfecta, Isala Hospital, Dokter van Heesweg 2, PO Box 10400, 8025 AB, Zwolle, The Netherlands
| | - Guus Janus
- Expert Center for Adults with Osteogenesis Imperfecta, Isala Hospital, Dokter van Heesweg 2, PO Box 10400, 8025 AB, Zwolle, The Netherlands
| | - Anton Franken
- Expert Center for Adults with Osteogenesis Imperfecta, Isala Hospital, Dokter van Heesweg 2, PO Box 10400, 8025 AB, Zwolle, The Netherlands
| |
Collapse
|
5
|
Elkington M, Kurinczuk JJ, Pasupathy D, Plachcinski R, Rogers J, Williams C, Rowe R. Postpartum haemorrhage occurring in UK midwifery units: A national population-based case-control study to investigate incidence, risk factors and outcomes. PLoS One 2023; 18:e0291795. [PMID: 37796876 PMCID: PMC10553245 DOI: 10.1371/journal.pone.0291795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/02/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVES To estimate the incidence of, and investigate risk factors for, postpartum haemorrhage (PPH) requiring transfer to obstetric care following birth in midwifery units (MU) in the UK; to describe outcomes for women who experience PPH requiring transfer to obstetric care. METHODS We conducted a national population-based case-control study in all MUs in the UK using the UK Midwifery Study System (UKMidSS). Between September 2019 and February 2020, 1501 women with PPH requiring transfer to obstetric care following birth in an MU, and 1475 control women were identified. We used multivariable logistic regression, generating adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to investigate risk factors for PPH requiring transfer to obstetric care. RESULTS The incidence of PPH requiring transfer to obstetric care following birth in an MU was 3.7% (95% CI 3.6%-3.9%). Factors independently associated with PPH requiring transfer to obstetric care were smoking during pregnancy (aOR = 0.73; 95% CI 0.56-0.94), nulliparity (aOR = 1.96; 95% CI 1.66-2.30), previous PPH (aOR = 2.67; 95% CI 1.67-4.25), complications in a previous pregnancy other than PPH (aOR = 2.40; 95% CI 1.25-4.60), gestational age ≥41 weeks (aOR = 1.36; 95% CI 1.10-1.69), instrumental birth (aOR = 2.69; 95% CI 1.53-4.72), third stage of labour ≥60 minutes (aOR = 5.56; 95% CI 3.93-7.88), perineal trauma (aOR = 4.67; 95% CI 3.16-6.90), and birthweight 3500-3999g (aOR = 1.71; 95% CI 1.42-2.07) or ≥4000g (aOR = 2.31; 95% CI 1.78-3.00). One in ten (10.6%) cases received a blood transfusion and one in five (21.0%) were admitted to higher level care. CONCLUSIONS The risk factors identified in this study align with those identified in previous research and with current guidelines for women planning birth in an MU in the UK. Maternal outcomes after PPH were broadly reassuring and indicative of appropriate management. NHS organisations should ensure that robust guidelines are in place to support management of PPH in MUs.
Collapse
Affiliation(s)
- Madeline Elkington
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jennifer J. Kurinczuk
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Dharmintra Pasupathy
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rachel Plachcinski
- Independent Parent, Patient and Public Involvement Consultant, Dewsbury, United Kingdom
| | - Jane Rogers
- Consultant Midwife, Formerly at University Hospitals Southampton, Southampton, United Kingdom
| | - Catherine Williams
- Independent Parent, Patient and Public Involvement Consultant, Henley on Thames, United Kingdom
| | - Rachel Rowe
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | |
Collapse
|
6
|
Zang Y, Hu Y, Lu H. Effects of different techniques during the second stage of labour on reducing perineal laceration: An overview of systematic reviews. J Clin Nurs 2023; 32:996-1013. [PMID: 35253295 DOI: 10.1111/jocn.16276] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/25/2022] [Accepted: 02/21/2022] [Indexed: 12/28/2022]
Abstract
AIM AND OBJECTIVE To summarize the evidence on the effects of different techniques during the second stage of labour on reducing perineal laceration depending on available systematic reviews to provide optimal evidence for decision-making. BACKGROUND Preventing perineal laceration has been considered an important part of improving women's health. Various techniques have been used to prevent perineal laceration during the second stage of labour. However, systematic reviews evaluating the effects of different techniques on reducing perineal laceration show inconsistent results. DESIGN Overview of systematic reviews. METHODS Five English and four Chinese databases were systematically searched for relevant systematic reviews and meta-analyses published between 1 January 2016 and 31 August 2021. The quality of the included reviews was assessed by the AMSTAR 2 tool. A narrative synthesis was conducted to report the results of moderate-to-high quality systematic reviews. The overview was reported according to the PRISMA statement. RESULTS Eighteen reviews were included, of which four reviews had moderate-to-high methodological quality. Perineal massage and warm compresses significantly decreased the incidence of third- or fourth-degree perineal laceration (moderate-quality evidence). Hands-off technique had no impact on perineal laceration (low-to-moderate quality evidence). Ritgen's manoeuvre could reduce the incidence of first-degree perineal laceration but increase the incidence of second-degree perineal laceration (very low-quality evidence). Spontaneous pushing (low-quality evidence) and delayed pushing (moderate-quality evidence) had no impact on the incidence of third- or fourth-degree perineal laceration. Upright positions did not increase the risk of third- or fourth-degree perineal laceration (very low- to low-quality evidence) but increased the risk of second-degree perineal laceration for women without epidural analgesia (low-quality evidence). CONCLUSIONS Perineal massage and warm compresses could be the better choice for preventing perineal laceration in the second stage of labour. RELEVANCE TO CLINICAL PRACTICE Midwives and obstetricians could use perineal massage and warm compresses to prevent perineal laceration and should consider women's preferences and experience with perineal techniques.
Collapse
Affiliation(s)
- Yu Zang
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Yinchu Hu
- School of Nursing, Peking University, Beijing, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China
| |
Collapse
|
7
|
Thams AB, Larsen MH, Rasmussen SC, Jeppegaard M, Krebs L. Incidence of postpartum hemorrhage and risk factors for recurrence in the subsequent pregnancy. Arch Gynecol Obstet 2023; 307:1217-1224. [PMID: 35593948 DOI: 10.1007/s00404-022-06591-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/22/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To assess incidence and risk factors for postpartum hemorrhage (PPH) and identify women at high risk of recurrence in the subsequent pregnancy. METHODS This register-based study includes data on women from the Capital Region of Denmark with two consecutive deliveries recorded in the Copenhagen Obstetric Database from 2007 to 2020. PPH, defined as a blood loss of 1000 mL or more within 24 h after delivery, was the primary outcome measure. We calculated incidence and recurrence rate of PPH and assessed possible risk factors at index and subsequent deliveries. RESULTS We included 44,800 women with 95,673 deliveries. The overall incidence of PPH was 6.3%. Women with previous PPH had a 3.5-fold increased risk of PPH in a subsequent delivery compared to unaffected women (19.1 vs. 5.4%; OR 4.1; 95% CI 3.7-4.5). Major risk factors for recurrence were PPH in combination with blood transfusion or manual removal of placenta at the index delivery. Labor induction in subsequent pregnancy increased the risk of recurrent PPH compared to spontaneous onset (OR 1.5; 95% CI 1.2-1.9), while planned caesarean section reduced the risk, compared to planned vaginal delivery (OR 0.6; 95% CI 0.4-0.7). CONCLUSION Previous PPH increases the risk of PPH in subsequent pregnancy 3.5-fold. The risk of recurrent PPH increases with labor induction and decreases with planned caesarean section in the subsequent pregnancy. To prevent recurrent PPH, personalized counseling based on risk factors, relevant labor history and maternal preferences is suggested.
Collapse
Affiliation(s)
- Amalie Birkmose Thams
- Department of Gynecology and Obstetrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - Marie Høygaard Larsen
- Department of Gynecology and Obstetrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Steen Christian Rasmussen
- Department of Gynecology and Obstetrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Maria Jeppegaard
- Department of Gynecology and Obstetrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Lone Krebs
- Department of Gynecology and Obstetrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
8
|
Abstract
Postpartum haemorrhage (PPH) remains the leading cause of pregnancy-related deaths worldwide. Typically, bleeding is controlled by timely obstetric measures in parallel with resuscitation and treatment of coagulopathy. Early recognition of abnormal coagulation is crucial and haemostatic support should be considered simultaneously with other strategies as coagulopathies contribute to the progression to massive haemorrhage. However, there is lack of agreement on important topics in the current guidelines for management of PPH. A clinical definition of PPH is paramount to understand the situation to which the treatment recommendations relate; however, reaching a consensus has previously proven difficult. Traditional definitions are based on volume of blood loss, which is difficult to monitor, can be misleading and leads to treatment delay. A multidisciplinary approach to define PPH considering vital signs, clinical symptoms, coagulation and haemodynamic changes is needed. Moreover, standardised algorithms or massive haemorrhage protocols should be developed to reduce the risk of morbidity and mortality and improve overall clinical outcomes in PPH. If available, point-of-care testing should be used to guide goal-directed haemostatic treatment. Tranexamic acid should be administered as soon as abnormal bleeding is recognised. Fibrinogen concentrate rather than fresh frozen plasma should be administered to restore haemostasis where there is elevated risk of fibrinogen deficiency (e.g., in catastrophic bleeding or in cases of abruption or amniotic fluid embolism) as it is a more concentrated source of fibrinogen. Lastly, organisational considerations are equally as important as clinical interventions in the management of PPH and have the potential to improve patient outcomes.
Collapse
|
9
|
Glonnegger H, Glenzer MM, Lancaster L, Barnes RF, von Drygalski A. Prepartum Anemia and Risk of Postpartum Hemorrhage: A Meta-Analysis and Brief Review. Clin Appl Thromb Hemost 2023; 29:10760296231214536. [PMID: 37968861 PMCID: PMC10655792 DOI: 10.1177/10760296231214536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Postpartum hemorrhage (PPH) is responsible for 30% to 50% of maternal deaths. There is conflicting evidence if prepartum anemia facilitates PPH. A comprehensive analysis of studies describing their relation is missing. An extensive database search was conducted applying the terms "anemia" OR "hemoglobin" AND "postpartum hemorrhage." We used a random-effects meta-analysis model to estimate an overall odds ratio (OR) for PPH and prepartum anemia, separating studies that were conformant and non-conformant with the World Health Organization (WHO) definitions for anemia. The search yielded 2519 studies, and 46 were appropriate for analysis. The meta-analyses of WHO-conformant (n = 22) and non-conformant (n = 24) studies showed that the risk of PPH was increased when anemia was present. The ORs were 1.45 (CL: 1.23-1.71) for WHO-conformant studies, 2.88 (CL: 1.38-6.02) for studies applying lower thresholds for anemia, and 3.28 (CL: 2.08-5.19) for undefined anemia thresholds. PPH risk appeared to increase with lower anemia thresholds. Prepartum anemia is associated with an increased risk of PPH, an observation that is important regarding improved anemia correction strategies such as iron supplementation.
Collapse
Affiliation(s)
- Hannah Glonnegger
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center-University of Freiburg, Freiburg, Germany
| | - Michael M. Glenzer
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, CA, USA
| | - Lian Lancaster
- Department of Emergency Medicine, The George Washington University Washington DC, Washington DC, USA
| | - Richard F.W. Barnes
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, CA, USA
| | - Annette von Drygalski
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, CA, USA
| |
Collapse
|
10
|
Erickson EN, Krol KM, Perkeybile AM, Connelly JJ, Myatt L. Oxytocin receptor single nucleotide polymorphism predicts atony-related postpartum hemorrhage. BMC Pregnancy Childbirth 2022; 22:884. [PMID: 36447139 PMCID: PMC9706912 DOI: 10.1186/s12884-022-05205-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Postpartum hemorrhage remains a key contributor to overall maternal morbidity in the United States. Current clinical assessment methods used to predict postpartum hemorrhage are unable to prospectively identify about 40% of hemorrhage cases. Oxytocin is a first-line pharmaceutical for preventing and treating postpartum hemorrhage, which acts through oxytocin receptors on uterine myocytes. Existing research indicates that oxytocin function is subject to variation, influenced in part by differences in the DNA sequence within the oxytocin receptor gene. One variant, rs53576, has been shown to be associated with variable responses to exogenous oxytocin when administered during psychological research studies. How this variant may influence myometrial oxytocin response in the setting of third stage labor has not been studied. We tested for differences in the frequency of the oxytocin receptor genotype at rs53576 in relationship to the severity of blood loss among a sample of individuals who experienced vaginal birth. METHODS A case-control prospective design was used to enroll 119 postpartum participants who underwent vaginal birth who were at least 37 weeks of gestation. Cases were defined by either a 1000 mL or greater blood loss or instances of heavier bleeding where parturients were given additional uterotonic treatment due to uterine atony. Controls were matched to cases on primiparity and labor induction status. Genotype was measured from a maternal blood sample obtained during the 2nd postpartum month from 95 participants. Statistical analysis included bivariate tests and generalized linear and Poisson regression modeling. RESULTS The distribution of the genotype across the sample of 95 participants was 40% GG (n = 38), 50.5% AG (n = 48) and 9.5% AA (n = 9). Blood loss of 1000 mL or greater occurred at a rate of 7.9% for GG, 12.5% for AG and 55.6% for AA participants (p = 0.005). Multivariable models demonstrated A-carriers (versus GG) had 275.2 mL higher blood loss (95% CI 96.9-453.4, p < 0.01) controlling for parity, intrapartum oxytocin, self-reported ancestry, active management of third stage or genital tract lacerations. Furthermore, A-carrier individuals had a 79% higher risk for needing at least one second-line treatment (RR = 1.79, 95% CI = 1.08-2.95) controlling for covariates. Interaction models revealed that A-carriers who required no oxytocin for labor stimulation experienced 371.4 mL greater blood loss (95% CI 196.6-546.2 mL). CONCLUSIONS We provide evidence of a risk allele in the oxytocin receptor gene that may be involved in the development of postpartum hemorrhage among participants undergoing vaginal birth, particularly among those with fewer risk factors. The findings, if reproducible, could be useful in studying pharmacogenomic strategies for predicting, preventing or treating postpartum hemorrhage.
Collapse
Affiliation(s)
- Elise N. Erickson
- grid.134563.60000 0001 2168 186XPresent Address: University of Arizona, Tucson, AZ USA ,grid.5288.70000 0000 9758 5690Oregon Health and Science University, OR Portland, USA
| | - Kathleen M. Krol
- grid.27755.320000 0000 9136 933XUniversity of Virginia, Charlottesville, VA USA
| | | | - Jessica J. Connelly
- grid.27755.320000 0000 9136 933XUniversity of Virginia, Charlottesville, VA USA
| | - Leslie Myatt
- grid.5288.70000 0000 9758 5690Oregon Health and Science University, OR Portland, USA
| |
Collapse
|
11
|
Tolossa T, Fetensa G, Zewde EA, Besho M, Jidha TD. Magnitude of postpartum hemorrhage and associated factors among women who gave birth in Ethiopia: a systematic review and meta-analysis. Reprod Health 2022; 19:194. [PMID: 36131345 PMCID: PMC9490897 DOI: 10.1186/s12978-022-01498-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and morbidity worldwide, particularly in resource-limited countries such as Ethiopia. Findings from a few studies were inconsistent and inconclusive. Therefore, this study aimed to estimates the pooled magnitude of PPH and factors associated with PPH among women who gave birth in Ethiopia. Methods Electronic databases such as Medline, Pub Med, Cochrane library, the Web of Science, and Google Scholar were used to search for articles. The search period for articles was conducted from 15th August 2021 to 15th November 2021. Data were extracted using a standardized data extraction checklist and the analyses were conducted using Stata version 14. The Cochrane Q test statistic and I2 statistics were used to assessing heterogeneity. To estimate the pooled magnitude of postpartum hemorrhage, a random-effects model was fitted. Association between PPH and independent variables was reported in odds ratio (OR) with 95% confidence interval (CI). Visual assessment of publication bias was assessed using a funnel plot and Egger’s test was used to check the significant presence of publication bias. Results A total of 876 studies were identified from several databases and nine studies fulfilled eligibility criteria and were included in the meta-analysis. The pooled magnitude of PPH in Ethiopia was 11.14% (95% CI 7.21, 15.07). The current meta-analysis revealed that lack of antenatal care follow-up (ANC) (OR = 6.52, 95% CI 2.87, 14.81), being multipara (OR = 1.88, 95% CI 1.25, 2.85), and having the previous history of PPH (OR = 7.59, 95% CI 1.88, 30.55) were found to be significantly associated with PPH. Conclusion In Ethiopia the magnitude of PPH was high, and lack of ANC up follow-up, being multipara, and having a previous history of PPH were risk factors for postpartum hemorrhage. Thus, improving antenatal care follow-up is needed to decrease the magnitude of postpartum hemorrhage. Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and morbidity worldwide, particularly in resource-limited countries such as Ethiopia. Findings from a few studies were inconsistent and inconclusive. Therefore, this study aimed to estimate the pooled magnitude of PPH and factors associated with PPH among women who gave birth in Ethiopia. Electronic databases such as Medline, Pub Med, Cochrane library, the Web of Science, and Google Scholar were used to search for articles. Data were extracted using a standardized data extraction checklist and the analyses were conducted using Stata version 14. The Cochrane Q test statistic and I2 statistics were used to assessing heterogeneity. To estimate the pooled magnitude of postpartum hemorrhage, a random-effects model was fitted. Association between PPH and independent variables was reported in odds ratio (OR) with 95% confidence interval (CI). The pooled magnitude of PPH in Ethiopia was 11.14% (95% CI 7.21, 15.07). The current meta-analysis revealed that lack of antenatal care follow-up (ANC) (OR = 6.52, 95% CI 2.87, 14.81), being multipara (OR = 1.88, 95% CI 1.25, 2.85), and having the previous history of PPH (OR = 7.59, 95% CI 1.88, 30.55) were found to be significantly associated with PPH. In Ethiopia the magnitude of PPH was high, and lack of ANC follow-up, being multipara, and having the previous history of PPH were risk factors for postpartum hemorrhage. Thus, improving antenatal care follow-up is needed to decrease the magnitude of postpartum hemorrhage.
Collapse
Affiliation(s)
- Tadesse Tolossa
- Department of Public Health, Institutes of Health Sciences, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia.
| | - Getahun Fetensa
- Department of Nursing, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia.,Department of Health Behavior and society, Faculty of public Health, Jimma medical center, Jimma University, Jimma, Ethiopia
| | - Edgeit Abebe Zewde
- Department of Biomedical Science, College of Health Sciences, Debretabor University, Debretabor, Ethiopia
| | - Merga Besho
- Department of Midwifery, School of Nursing and Midwifery, Wollega University, Nekemte, Ethiopia
| | - Tafese Dejene Jidha
- College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| |
Collapse
|
12
|
Lao TT, Wong LL, Hui SYA, Sahota DS. Iron Deficiency Anaemia and Atonic Postpartum Haemorrhage Following Labour. Reprod Sci 2022; 29:1102-1110. [PMID: 34993930 DOI: 10.1007/s43032-021-00534-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/03/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this retrospective cohort study is to determine if iron deficiency anaemia (IDA) is associated with increased atonic postpartum haemorrhage (PPH) following labour. Women with singleton pregnancy carried to 24 or more weeks gestation, who were delivered under our care from 1997 to 2019, constituted the study population. A diagnosis of IDA was based on the finding of haemoglobin <10 g/dL and serum ferritin <15 μg/L in the absence of haemoglobinopathies. Women with elective caesarean section were excluded. Maternal characteristics, use of oxytocin, labour outcome and occurrence of PPH were compared between women with and without a diagnosis of IDA. The 1032 women (0.86%) with IDA exhibited slightly but significantly different maternal characteristics and had significantly higher incidence of total (4.5% versus 3.2%, p = 0.024) and atonic PPH (3.1% versus 2.0%, p = 0.011) despite similar incidences of labour induction, augmentation, and instrumental and intrapartum caesarean delivery. Multivariate analysis with adjustment for the effects of age, body mass index, height, parity, abortion history, labour induction and augmentation, instrumental delivery and infant macrosomia demonstrated that IDA was independently associated with total PPH (adjusted relative risk, aRR: 1.455, 95% confidence ratio, CI: 1.040-2.034) and atonic PPH (aRR: 1.588, 95% CI: 1.067-2.364). Our results indicate that despite the low prevalence in our population, IDA was independently associated with atonic PPH, probably consequent to placental adaptive changes in the presence of IDA. The correction and prevention of IDA could be the most important measure in countering the rising global prevalence of atonic PPH.
Collapse
Affiliation(s)
- Terence T Lao
- Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, 1/F, Block E, Shatin, Hong Kong, People's Republic of China.
| | - Lulu L Wong
- Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, 1/F, Block E, Shatin, Hong Kong, People's Republic of China
| | - Shuk Yi Annie Hui
- Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, 1/F, Block E, Shatin, Hong Kong, People's Republic of China
| | - Daljit S Sahota
- Department of Obstetrics & Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, 1/F, Block E, Shatin, Hong Kong, People's Republic of China
| |
Collapse
|
13
|
van Dijk WEM, Nijdam JS, Haitjema S, de Groot MCH, Huisman A, Punt MC, Evers ACC, Schutgens REG, Lely AT, van Galen KPM. Platelet count and indices as postpartum hemorrhage risk factors: a retrospective cohort study. J Thromb Haemost 2021; 19:2873-2883. [PMID: 34339085 PMCID: PMC9292153 DOI: 10.1111/jth.15481] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Severe postpartum hemorrhage (SPPH) is the leading cause of maternal mortality and morbidity worldwide. Platelet anomalies frequently occur during pregnancy. However, their role in the etiology of SPPH is largely unknown. OBJECTIVE To study the relation between platelet parameters and SPPH. METHODS This retrospective single-center cohort included deliveries between 2009 and 2017. SPPH was defined as ≥1000 ml blood loss within 24 h after delivery. Platelet parameters were measured within 72 h before delivery. Multiple imputation was performed for missing data. Odds ratios were adjusted (aORs) for maternal age, multiple gestation, macrosomia, induction of labor, preeclampsia, and hemolysis, elevated liver enzymes, and low platelets syndrome. RESULTS A total of 23 205 deliveries were included. Of the 2402 (10.4%) women with thrombocytopenia (<150 × 109 /L), 10.3% developed SPPH, compared with 7.6% of women with a normal platelet count (aOR: 1.34, 95% CI: 1.14-1.59). Women with a platelet count of <50 × 109 /L were most at risk (aOR of 2.24 [1.01-4.94]) compared with the reference group with normal platelet counts; the aOR was 1.22 (0.77-1.93) for the 50-99 × 109 /L platelet count group and 1.31 (1.10-1.56) for the 100-149 × 109 /L platelet count group. Plateletcrit was associated with SPPH (aOR 1.15 [1.08-1.21] per 0.05% decrease), and, although rarely present, a platelet distribution width (PDW) ≥23% (n = 22) also increased the odds of SPPH (aOR 6.05 [2.29-16.20]). CONCLUSION Different degrees of thrombocytopenia were independently associated with the occurrence of SPPH. Despite their relation to SPPH, plateletcrit and a PDW of ≥23% have limited additional value in addition to platelet count.
Collapse
Affiliation(s)
- Wobke E. M. van Dijk
- Benign Hematology, Van CreveldkliniekUniversity Medical CenterUtrechtThe Netherlands
| | | | - Saskia Haitjema
- Clinical Chemistry and HematologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Mark C. H. de Groot
- Clinical Chemistry and HematologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Albert Huisman
- Clinical Chemistry and HematologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marieke C. Punt
- Benign Hematology, Van CreveldkliniekUniversity Medical CenterUtrechtThe Netherlands
| | | | - Roger E. G. Schutgens
- Benign Hematology, Van CreveldkliniekUniversity Medical CenterUtrechtThe Netherlands
| | - A. Titia Lely
- Obstetrics and GynecologyUniversity Medical Center UtrechtUtrechtNetherlands
| | - Karin P. M. van Galen
- Benign Hematology, Van CreveldkliniekUniversity Medical CenterUtrechtThe Netherlands
| |
Collapse
|
14
|
Veen CSB, Huisman EJ, Romano LGR, Schipaanboord CWA, Cnossen MH, de Maat MPM, Leebeek FWG, Kruip MJHA. Outcome of Surgical Interventions and Deliveries in Patients with Bleeding of Unknown Cause: An Observational Study. Thromb Haemost 2021; 121:1409-1416. [PMID: 33853179 DOI: 10.1055/s-0041-1726344] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The most optimal management for patients with bleeding of unknown cause (BUC) is unknown, as limited data are available. OBJECTIVE Evaluate management and outcome of surgical procedures and deliveries in patients with BUC. MATERIALS AND METHODS All patients ≥12 years of age, referred to a tertiary center for a bleeding tendency, were included. Bleeding phenotype was assessed and hemostatic laboratory work-up was performed. Patients were diagnosed with BUC or an established bleeding disorder (BD). Data on bleeding and treatment during surgical procedures and delivery following diagnosis were collected. RESULTS Of 380 included patients, 228 (60%) were diagnosed with BUC and 152 (40%) with an established BD. In 14/72 (19%) surgical procedures major bleeding occurred and 14/41 (34%) deliveries were complicated by major postpartum hemorrhage (PPH). More specifically, 29/53 (55%) of the BUC patients who underwent surgery received prophylactic treatment to support hemostasis. Despite these precautions, 4/29 (14%) experienced major bleeding. Of BUC patients not treated prophylactically, bleeding occurred in 6/24 (25%). Of pregnant women with BUC, 2/26 (8%) received prophylactic treatment during delivery, one women with and 11 (46%) women without treatment developed major PPH. CONCLUSION Bleeding complications are frequent in BUC patients, irrespective of pre- or perioperative hemostatic treatment. We recommend a low-threshold approach toward administration of hemostatic treatment in BUC patients, especially during delivery.
Collapse
Affiliation(s)
- Caroline S B Veen
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Elise J Huisman
- Department of Paediatric Haematology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Lorenzo G R Romano
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Marjon H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Moniek P M de Maat
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Frank W G Leebeek
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marieke J H A Kruip
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
15
|
Ginström Ernstad E, Spangmose AL, Opdahl S, Henningsen AKA, Romundstad LB, Tiitinen A, Gissler M, Wennerholm UB, Pinborg A, Bergh C, Malchau SS. Perinatal and maternal outcome after vitrification of blastocysts: a Nordic study in singletons from the CoNARTaS group. Hum Reprod 2020; 34:2282-2289. [PMID: 31687765 DOI: 10.1093/humrep/dez212] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/21/2019] [Accepted: 09/06/2019] [Indexed: 12/17/2022] Open
Abstract
STUDY QUESTION Is transfer of vitrified blastocysts associated with higher perinatal and maternal risks compared with slow-frozen cleavage stage embryos and fresh blastocysts? SUMMARY ANSWER Transfer of vitrified blastocysts is associated with a higher risk of preterm birth (PTB) when compared with slow-frozen cleavage stage embryos and with a higher risk of a large baby, hypertensive disorders in pregnancy (HDPs) and postpartum hemorrhage (PPH) but a lower risk of placenta previa when compared with fresh blastocysts. WHAT IS KNOWN ALREADY Transfer of frozen-thawed embryos (FETs) plays a central role in modern fertility treatment, limiting the risk of ovarian hyperstimulation syndrome and multiple pregnancies. Following FET, several studies report a lower risk of PTB, low birth weight (LBW) and small for gestational age (SGA) yet a higher risk of fetal macrosomia and large for gestational age (LGA) compared with fresh embryos. In recent years, the introduction of new freezing techniques has increased treatment success. The slow-freeze technique combined with cleavage stage transfer has been replaced by vitrification and blastocyst transfer. Only few studies have compared perinatal and maternal outcomes after vitrification and slow-freeze and mainly in cleavage stage embryos, with most studies indicating similar outcomes in the two groups. Studies on perinatal and maternal outcomes following vitrified blastocysts are limited. STUDY DESIGN, SIZE, DURATION This registry-based cohort study includes singletons born after frozen-thawed and fresh transfers following the introduction of vitrification in Sweden and Denmark, in 2002 and 2009, respectively. The study includes 3650 children born after transfer of vitrified blastocysts, 8123 children born after transfer of slow-frozen cleavage stage embryos and 4469 children born after transfer of fresh blastocysts during 2002-2015. Perinatal and maternal outcomes in singletons born after vitrified blastocyst transfer were compared with singletons born after slow-frozen cleavage stage transfer and singletons born after fresh blastocyst transfer. Main outcomes included PTB, LBW, macrosomia, HDP and placenta previa. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were obtained from the CoNARTaS (Committee of Nordic ART and Safety) group. Based on national registries in Sweden, Finland, Denmark and Norway, the CoNARTaS cohort includes all children born after ART treatment in public and private clinics 1984-2015. Outcomes were assessed with logistic multivariable regression analysis, adjusting for the country and year of birth, maternal age, body mass index, parity, smoking, parental educational level, fertilisation method (IVF/ICSI), single embryo transfer, number of gestational sacs and the child's sex. MAIN RESULTS AND THE ROLE OF CHANCE A higher risk of PTB (<37 weeks) was noted in the vitrified blastocyst group compared with the slow-frozen cleavage stage group (adjusted odds ratio, aOR [95% CI], 1.33 [1.09-1.62]). No significant differences were observed for LBW (<2500 g), SGA, macrosomia (≥4500 g) and LGA when comparing the vitrified blastocyst with the slow-frozen cleavage stage group. For maternal outcomes, no significant difference was seen in the risk of HDP, placenta previa, placental abruption and PPH in the vitrified blastocyst versus the slow frozen cleavage stage group, although the precision was limited.When comparing vitrified and fresh blastocysts, we found higher risks of macrosomia (≥4500 g) aOR 1.77 [1.35-2.31] and LGA aOR 1.48 [1.18-1.84]. Further, the risks of HDP aOR 1.47 [1.19-1.81] and PPH aOR 1.68 [1.39-2.03] were higher in singletons born after vitrified compared with fresh blastocyst transfer while the risks of SGA aOR 0.58 [0.44-0.78] and placenta previa aOR 0.35 [0.25-0.48] were lower. LIMITATIONS, REASONS FOR CAUTION Since vitrification was introduced simultaneously with blastocyst transfer in Sweden and Denmark, it was not possible to explore the effect of vitrification per se in this study. WIDER IMPLICATIONS OF THE FINDINGS The results from the change of strategy to vitrification of blastocysts are reassuring, indicating that the freezing technique per se has no major influence on the perinatal and maternal outcomes. The higher risk of PTB may be related to the extended embryo culture rather than vitrification. STUDY FUNDING/COMPETING INTEREST(S) The study is part of the ReproUnion Collaborative study, co-financed by the European Union, Interreg V ÖKS. The study was also financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (LUA/ALF 70940), Hjalmar Svensson Research Foundation and NordForsk (project 71 450). There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER ISRCTN11780826.
Collapse
Affiliation(s)
- Erica Ginström Ernstad
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, East Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anne Lærke Spangmose
- The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Signe Opdahl
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Liv Bente Romundstad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Mika Gissler
- THL, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, East Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anja Pinborg
- The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christina Bergh
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sara Sofia Malchau
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, East Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
16
|
Chen B, Zhang L, Wang D, Li J, Hou Y, Yang T, Li N, Qiao C. Nomogram to predict postpartum hemorrhage in cesarean delivery for women with scarred uterus: A retrospective cohort study in China. J Obstet Gynaecol Res 2020; 46:1772-1782. [PMID: 32662194 DOI: 10.1111/jog.14354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/09/2020] [Accepted: 05/23/2020] [Indexed: 01/21/2023]
Abstract
AIM To develop nomograms predicting the risk of postpartum hemorrhage (PPH) in cesarean delivery for singleton pregnant women with a scarred uterus in the north of China. METHODS A retrospective cohort study was conducted. Totally 3722 singleton pregnant women with a scarred uterus who underwent a cesarean delivery in a large teaching hospital of north China between January 2013 and December 2017 were enrolled. Nomograms, a kind of user-friendly tool, were developed to predict PPH (blood loss ≥1000 mL or accompanied by signs or symptoms of hypovolemia within 24 h after the birth process) based on the model generated by logistic regression analysis. The discrimination and calibration of models were evaluated, and decision curve analysis was developed. RESULTS Among 3722 enrolled women, 243 (6.53%) had PPH. There are six identified factors associated with PPH: maternal age, placental location, placenta previa, hypertensive disorders of pregnancy, fetal position and placenta accreta spectrum (PAS). The model achieved a good calibration (Hosmer-Lemeshow test P value 0.77) and discrimination (area under curve c-statistics 0.90, 95% confidence interval 0.86-0.93). Decision curve analysis showed the threshold probability by using our model is between 1.0% and 85.7%. A nomogram was developed accordingly. And another nomogram for women without placenta previa and PAS was also developed. CONCLUSION Two nomograms were first generated to predict PPH, respectively, for women with a scarred uterus and for women with a scarred uterus who do not have placenta previa or PAS. Placental location and fetal position were found to be closely related to PPH.
Collapse
Affiliation(s)
- Bingnan Chen
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine, China Medical University, Shenyang, China.,Key Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Liyang Zhang
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine, China Medical University, Shenyang, China.,Key Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Di Wang
- Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Jiapo Li
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine, China Medical University, Shenyang, China.,Key Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Yue Hou
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine, China Medical University, Shenyang, China.,Key Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Tian Yang
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine, China Medical University, Shenyang, China.,Key Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Na Li
- Key Laboratory of Maternal-Fetal Medicine, China Medical University, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Chong Qiao
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine, China Medical University, Shenyang, China.,Key Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| |
Collapse
|
17
|
Relationship between gestational weight gain and amount of postpartum bleeding. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.636511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
18
|
Prapawichar P, Ratinthorn A, Utriyaprasit K, Viwatwongkasem C. Maternal and health service predictors of postpartum hemorrhage across 14 district, general and regional hospitals in Thailand. BMC Pregnancy Childbirth 2020; 20:172. [PMID: 32183723 PMCID: PMC7079495 DOI: 10.1186/s12884-020-2846-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/27/2020] [Indexed: 12/28/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) is a preventable complication, however, it remains being the leading cause of maternal mortality and morbidity worldwide including Thailand. Methods A case-control study to examine the risk factors associated with PPH across the hospitals under the Ministry of Public Health in Thailand, was conducted. A total of 1833 patient birth records and hospital profiles including human and physical resources from 14 hospitals were obtained. A multiple logistic regression was used identifing the factors that are significantly associated with PPH. Results The results show that the rate of PPH varied across the hospitals ranging from 1.4 to 10.6%. Women with past history of PPH were more likely to have increased risk of having PPH by 10.97 times (95% CI 2.27,53.05) compared to those who did not. The odds of PPH was higher in district and general hospitals by 14 (95% CI 3.95,50.04) and 7 (95% CI 2.27,23.27) times respectively, compared to regional hospitals. The hospitals which had inadequate nurse midwife to patient ratio (OR 2.31,95% CI 1.08,4.92), lacked nurse midwives with working experience of 6–10 years (OR 2.35, 95% CI 1.41,3.92), as well as inadequate equipment and supplies for emergency obstetric care (OR 6.47, 95% CI 1.93,21.63), had significantly higher incidence of having PPH, respectively. Conclusions This study provides interesting information that the rate of PPH varies across the hospitals in Thailand, in particular where essential nurse midwives, equipment, and supplies are limited. Therefore, improving health care services by allocating sufficient human and physical resources would contribute to significantly reduce this complication.
Collapse
Affiliation(s)
- Phat Prapawichar
- Faculty of Nursing Science, Mahidol University, Bangkok, Thailand
| | | | | | - Chukiat Viwatwongkasem
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, 10400, Thailand
| |
Collapse
|
19
|
Adegoke O, Danso-Bamfo S, Sheehy M, Tarimo V, Burke TF, Garg LF. A condom uterine balloon device among referral facilities in Dar Es Salaam: an assessment of perceptions, barriers and facilitators one year after implementation. BMC Pregnancy Childbirth 2020; 20:34. [PMID: 31931785 PMCID: PMC6958625 DOI: 10.1186/s12884-020-2721-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is the leading cause of maternal death in Tanzania. The Every Second Matters for Mothers and Babies- Uterine Balloon Tamponade (ESM-UBT) device was developed to address this problem in women with atonic uterus. The objective of this study was to understand the barriers and facilitators to optimal use of the device, in Dar es Salaam Tanzania 1 year after implementation. METHODS Semi-structured interviews of skilled-birth attendants were conducted between May and July 2017. Interviews were recorded, coded and analyzed for emergent themes. RESULTS Among the participants, overall there was a positive perception of the ESM-UBT device. More than half of participants reported the device was readily available and more than 1/3 described ease and success with initial use. Barriers included fear and lack of refresher training. Finally, participants expressed a need for training and device availability at peripheral hospitals. CONCLUSION The implementation and progression to optimal use of the ESM-UBT device in Tanzania is quite complex. Ease of use and the prospect of saving a life/preserving fertility strongly promoted use while fear and lack of high-level buy-in hindered utilization of the device. A thorough understanding and investigation of these facilitators and barriers are required to increase uptake of the ESM-UBT device.
Collapse
Affiliation(s)
- Oluwakemi Adegoke
- Department of Emergency Medicine, Division of Global Health Innovation, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA. .,Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Sandra Danso-Bamfo
- Department of Emergency Medicine, Division of Global Health Innovation, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA
| | - Margaret Sheehy
- Department of Emergency Medicine, Division of Global Health Innovation, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Thomas F Burke
- Department of Emergency Medicine, Division of Global Health Innovation, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lorraine F Garg
- Department of Emergency Medicine, Division of Global Health Innovation, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA
| |
Collapse
|
20
|
Veen CSB, van der Reijken IS, Jansen AJG, Schipaanboord CWA, Visser W, de Maat MPM, Leebeek FWG, Duvekot JJ, Kruip MJHA. Severe postpartum haemorrhage as first presenting symptom of an inherited bleeding disorder. Haemophilia 2019; 25:1051-1058. [PMID: 31583797 DOI: 10.1111/hae.13846] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/11/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Postpartum haemorrhage (PPH) is the major cause of maternal death worldwide. Haemostatic abnormalities are independently associated with a significantly increased risk for severe PPH. In this study, the value of haemostatic evaluation in women with severe PPH was explored. AIM To investigate the occurrence of previously unknown inherited bleeding disorders in women with severe PPH. METHODS Women with severe PPH (blood loss of ≥2000 mL) between 2011 and 2017, referred to the haematology outpatient clinic for haemostatic evaluation, were retrospectively included. A bleeding disorder was diagnosed based on (inter)national guidelines, or when having a clear bleeding phenotype, not fulfilling any diagnostic criteria or laboratory abnormalities, this being classified as Bleeding of Unknown Cause (BUC). Logistic regression was used to model the association between diagnosis and obstetrical causes and risk factors for PPH. RESULTS In total, 85 women with PPH were included. In 23% (n = 16), a mild bleeding disorder was diagnosed, including low von Willebrand factor (Low VWF 8/16), platelet function disorders (PFD 5/16), BUC (2/16) and von Willebrand disease type 1 (1/16). No significant associations were found between obstetrical causes or risk factors for PPH and the presence of a bleeding disorder. CONCLUSION In 23% of women with severe PPH, a mild bleeding disorder was diagnosed, independent of obstetrical causes or risk factors for PPH. This implies that severe PPH can be the first clinical symptom of an inherited bleeding disorder. Therefore, to optimize clinical management, haemostatic evaluation after severe PPH is recommended.
Collapse
Affiliation(s)
- Caroline S B Veen
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Irene S van der Reijken
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - A J Gerard Jansen
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | - Willy Visser
- Department of Obstetrics & Gynaecology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Vascular Medicine, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Moniek P M de Maat
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Frank W G Leebeek
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics & Gynaecology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marieke J H A Kruip
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
21
|
Edwards HM, Svare JA, Wikkelsø AJ, Lauenborg J, Langhoff-Roos J. The increasing role of a retained placenta in postpartum blood loss: a cohort study. Arch Gynecol Obstet 2019; 299:733-740. [PMID: 30730011 DOI: 10.1007/s00404-019-05066-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 01/25/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the association between quantity of blood loss, duration of the third stage of labour, retained placenta and other risk factors, and to describe the role of a retained placenta depending on the cutoff used to define postpartum haemorrhage. METHODS Cohort study of all vaginal deliveries at two Danish maternity units between 1 January 2009 and 31 December 2013 (n = 43,357), univariate and multivariate linear regression statistical analyses. RESULTS A retained placenta was shown to be a strong predictor of quantity of blood loss and duration of the third stage of labour a weak predictor of quantity of blood loss. The predictive power of the third stage of labour was further reduced in the multivariate analysis when including retained placenta in the model. There was an increase in the role of a retained placenta depending on the cutoff used to define postpartum haemorrhage, increasing from 12% in cases of blood loss ≥ 500 ml to 53% in cases of blood loss ≥ 2000 ml CONCLUSION: The predictive power of duration of the third stage of labour in regard to postpartum blood loss was diminished by the influence of a retained placenta. A retained placenta was, furthermore, present in the majority of most severe cases.
Collapse
Affiliation(s)
- Hellen McKinnon Edwards
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Jens Anton Svare
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Anne Juul Wikkelsø
- Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Jeannet Lauenborg
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Jens Langhoff-Roos
- Department of Obstetrics, Juliane Marie Centre, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| |
Collapse
|
22
|
Abstract
As major stakeholders in the labor and delivery suite, obstetric anesthesiologists are frequently called upon to provide their unique skill sets and expertise to the management of postpartum hemorrhage, whether anticipated or not. Essential contributions of the anesthesia team ideally begin in the antenatal period with referral of women at high risk of postpartum hemorrhage to an outpatient obstetric anesthesia clinic where a tailored plan for both urgent or scheduled delivery for women with an anticipated complex delivery can be formulated. Maternal safety can be greatly improved if comorbidities are identified early and strategies to address these issues are proposed and known by the obstetric anesthesia team. Participation of the obstetric anesthesiology team is crucial in the development of systematic approaches that are customized to each institution and should comprise the creation and dissemination of algorithms and guidelines that are anesthesia specific, including detailed protocols for the labor and delivery unit and operating rooms, at large. Because management of postpartum hemorrhage requires a coordinated team effort, and may not always be planned, the anesthesia team should be prepared at all times to provide the appropriate anesthetic management and advanced cardiovascular support. The involvement of the anesthesia team should not only be limited to the immediate intrapartum period, but should also extend to the postpartum period where adequate anesthetic/analgesic plans will enhance maternal safety and recovery.
Collapse
Affiliation(s)
- Laurence Ring
- Department of Anesthesiology, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, 630 West 168th St PH-5, New York, NY 10032, United States
| | - Ruth Landau
- Department of Anesthesiology, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, 630 West 168th St PH-5, New York, NY 10032, United States.
| |
Collapse
|
23
|
Favilli A, Tosto V, Ceccobelli M, Bini V, Gerli S. Risk factors analysis and a scoring system proposal for the prediction of retained placenta after vaginal delivery. Eur J Obstet Gynecol Reprod Biol 2018; 228:180-185. [DOI: 10.1016/j.ejogrb.2018.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/16/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
|
24
|
Keating J, Barnett M, Watkins V, Gwini SM. The association between ragged or incomplete membranes and postpartum haemorrhage: A retrospective cohort study. Aust N Z J Obstet Gynaecol 2018; 58:612-619. [PMID: 29380357 DOI: 10.1111/ajo.12775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 12/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association between an incomplete placenta and postpartum haemorrhage (PPH) is well documented; however, the significance of ragged or incomplete membranes has not been explored as an independent risk factor for PPH. AIMS To explore the association between the completeness of the amniotic and chorionic membranes and the risk of PPH, independent to placental status. MATERIALS AND METHODS 37 176 birth records were retrospectively extracted from the period 1 July, 2008 to 30 June, 2016 from the databases of two public hospitals in Melbourne, Australia. Following application of specific exclusion and inclusion criteria, including non-complete placentas, 5718 records were available for analysis. These records were grouped based on membrane status (complete, ragged or incomplete) and outcome (PPH or no PPH). RESULTS Primary PPH rates were 14.8% in women with complete membranes, 20.2% in women with ragged membranes and 25.8% in women with incomplete membranes. Following statistical adjustment, the risk ratios for PPH were 1.32 (95% CI: 1.15-1.50) and 1.70 (95% CI: 1.41-2.04) in women with ragged and incomplete membranes, respectively. CONCLUSIONS Both ragged and incomplete membranes were found to be independent risk factors for primary PPH. This previously un-discussed association has the potential to influence clinical practice changes, particularly with regard to the ongoing clinical relevance and use of the terms 'ragged' and 'incomplete' membranes.
Collapse
Affiliation(s)
- Julia Keating
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Malcolm Barnett
- Women and Children Program, Eastern Health, Melbourne, Victoria, Australia
| | - Vanessa Watkins
- Women and Children Program, Eastern Health, Melbourne, Victoria, Australia.,Western Health, Sunshine Hospital, Melbourne, Victoria, Australia
| | - Stella May Gwini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
25
|
Cho GJ, Shim JY, Ouh YT, Kim LY, Lee TS, Ahn KH, Hong SC, Oh MJ, Kim HJ, Lee PR. Previous uterine artery embolization increases the rate of repeat embolization in a subsequent pregnancy. PLoS One 2017; 12:e0185467. [PMID: 28950018 PMCID: PMC5614611 DOI: 10.1371/journal.pone.0185467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/13/2017] [Indexed: 11/18/2022] Open
Abstract
This study aimed to determine the rate of repeat uterine artery embolization (UAE) in women with a previous UAE. Study data were collected from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service for 2009–2013. We enrolled women who had a first delivery in 2009 and a second delivery between 2010 and 2013. Among 226,408 women who had a first delivery in 2009, 296 underwent UAE. A total of 127,506 women had a second delivery between 2010 and 2013. Of 296 women who underwent UAE after the first delivery, 94 had a second delivery between 2010 and 2013. Women with a previous UAE had a higher rate of UAE at the second delivery than women without a previous UAE. Multivariate adjusted analysis showed that a UAE at the first delivery increased the rate of UAE at the second delivery (odds ratio 25.56, 95% confidence interval 9.86–66.23). Women with a previous UAE should be appropriately counseled and monitored for the need for a repeat UAE.
Collapse
Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jae-Yoon Shim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- * E-mail: (MJO); (JYS)
| | - Yung-Taek Ouh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Log Young Kim
- The Health Insurance Review & Assessment Service of Korea, Seoul, Korea
| | - Tae Seon Lee
- The Health Insurance Review & Assessment Service of Korea, Seoul, Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- * E-mail: (MJO); (JYS)
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Pil Ryang Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
26
|
Chavkin U, Wainstock T, Sheiner E, Sergienko R, Walfisch A. Perinatal outcome of pregnancies complicated with extreme birth weights at term. J Matern Fetal Neonatal Med 2017; 32:198-202. [DOI: 10.1080/14767058.2017.1376048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Uri Chavkin
- Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Soroka University Medical Center, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
| | | |
Collapse
|
27
|
Greenbaum S, Wainstock T, Dukler D, Leron E, Erez O. Underlying mechanisms of retained placenta: Evidence from a population based cohort study. Eur J Obstet Gynecol Reprod Biol 2017; 216:12-17. [PMID: 28692888 DOI: 10.1016/j.ejogrb.2017.06.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 06/06/2017] [Accepted: 06/23/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine risk factors for retained placenta, and to identify supporting epidemiologic evidence for the three previously-proposed mechanisms: (i) invasive placentation, (ii) placental hypo-perfusion, and (iii) inadequate uterine contractility. DESIGN A retrospective population-based cohort study. SETTING AND POPULATION Israeli population in the southern district. METHODS Data were analyzed from a tertiary hospital database, between 1989 and 2014, using univariate tests and generalized estimating equation (GEE) multivariable models. MAIN OUTCOME MEASURES Prevalence of retained placenta. RESULTS The study population included 205,522 vaginal deliveries of which 4.8% (n=9870) were complicated with retained placenta. Previous intra-uterine procedures and placenta-related pregnancy complications were found to be significant risk factors for retained placenta (history of cesarean section aOR=8.82, 95%CI 8.35-9.31; history of curettage aOR=12.80, 95%CI 10.57-15.50; pre-eclampsia aOR=1.25, 95%CI 1.14-1.38; delivery of a small for gestational age neonate aOR=1.08, 95%CI 1.01-1.16; stillbirth aOR=2.34, 95%CI 1.98-2.77). During labour, the risk for retained placenta was increased in presence of arrest of dilatation (aOR=2.03, 95%CI 1.08-3.82) or arrest of descent (aOR=1.55, 95%CI 1.22-1.96). Infections of the uterine cavity during labour were also found to be strongly associated with increased risk of retained placenta (endometritis aOR=2.21, 95%CI 1.64-2.97; chorioamnionitis aOR=3.35, 95% CI 2.78-4.04). CONCLUSIONS Supporting epidemiologic evidence were found for all three underlying mechanisms. In addition, there is evidence to suggest that intrauterine infection and inflammation may also be a possible pathology associated with retained placenta. TWEETABLE ABSTRACT Risk factors for retained placenta support previously proposed mechanisms in a large cohort study.
Collapse
Affiliation(s)
- Shirley Greenbaum
- Department of Obstetrics & Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Tamar Wainstock
- Department of Public health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Doron Dukler
- Department of Obstetrics & Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Elad Leron
- Department of Obstetrics & Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Offer Erez
- Department of Obstetrics & Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel.
| |
Collapse
|
28
|
Farina A, Bernabini D, Zucchini C, De Sanctis P, Quezada MS, Mattioli M, Rizzo N. Elevated maternal placental protein 13 serum levels at term of pregnancy in postpartum major hemorrhage (>1000 mLs). A prospective cohort study. Am J Reprod Immunol 2017; 78. [DOI: 10.1111/aji.12702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/11/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Antonio Farina
- Division of Obstetrics and Gynecology St. Orsola‐Malpighi PolyclinicDepartment of Medical and Surgical Sciences (DIMEC)University of Bologna Bologna BO Italy
| | - Dalila Bernabini
- Division of Obstetrics and Gynecology St. Orsola‐Malpighi PolyclinicDepartment of Medical and Surgical Sciences (DIMEC)University of Bologna Bologna BO Italy
| | - Cinzia Zucchini
- Department of ExperimentalDiagnostic and Specialty Medicine (DIMES)Unit of HistologyEmbryology and Applied BiologyUniversity of Bologna Bologna BO Italy
| | - Paola De Sanctis
- Department of ExperimentalDiagnostic and Specialty Medicine (DIMES)Unit of HistologyEmbryology and Applied BiologyUniversity of Bologna Bologna BO Italy
| | - Maria Soledad Quezada
- Fetal Medicine UnitDepartment of Obstetrics and GynecologyHospital Universitario “12 de Octubre”Faculty of MedicineUniversidad Complutense de Madrid Madrid Spain
| | - Mara Mattioli
- Division of Obstetrics and Gynecology St. Orsola‐Malpighi PolyclinicDepartment of Medical and Surgical Sciences (DIMEC)University of Bologna Bologna BO Italy
| | - Nicola Rizzo
- Division of Obstetrics and Gynecology St. Orsola‐Malpighi PolyclinicDepartment of Medical and Surgical Sciences (DIMEC)University of Bologna Bologna BO Italy
| |
Collapse
|
29
|
Rubio-Álvarez A, Molina-Alarcón M, Hernández-Martínez A. Relationship between the degree of perineal trauma at vaginal birth and change in haemoglobin concentration. Women Birth 2017; 30:382-388. [PMID: 28412037 DOI: 10.1016/j.wombi.2017.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 02/21/2017] [Accepted: 02/26/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Postpartum anaemia is a problem with high prevalence that significantly affects maternal recovery. Among the causal factors is perineal trauma. However, it is still not known what degree of perineal trauma produces a greater reduction of haemoglobin. AIM To assess the relationship between the degree of perineal trauma and change in haemoglobin concentration at vaginal birth. METHODS An observational, analytical retrospective cohort study was performed at the Mancha-Centro Hospital (Spain) during the period 2010-2014. Data were collected regarding 3479 women who gave birth vaginally. The main outcome variable was the change in haemoglobin concentration. Multivariate analysis by means of multiple linear regression was performed to control possible confounding factors and to determine the net effect of each degree of perineal trauma on haemoglobin reduction. FINDINGS Of the total sample, 20.1% of women (699) had an intact perineum, 41.6% (1446) experienced some form of perineal trauma, but not episiotomy, and the remaining 38.3% of women (1334) underwent an episiotomy. The average reduction of haemoglobin was 1.46g/dL (Standard Deviation (SD)=1.09g/dL) for women without episiotomy with a second degree tear and 2.07g/dL (SD=1.24g/dL) for women who had an episiotomy and no perineal tear. The greatest reduction occurred among women with episiotomy and a third or fourth degree tear with a decrease of 3.10g/dL (SD=1.32g/dL). CONCLUSION Episiotomy is related to greater reduction of haemoglobin concentration in comparison with all degrees of spontaneous perineal trauma. The use of episiotomy should be strictly limited.
Collapse
|
30
|
Postpartum hemorrhage following vaginal delivery: risk factors and maternal outcomes. J Perinatol 2017; 37:243-248. [PMID: 27977018 PMCID: PMC5334143 DOI: 10.1038/jp.2016.225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/24/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Limited understanding of risk factors exists for postpartum hemorrhage (PPH) post-vaginal delivery. The aim of this study was to identify risk factors for PPH post-vaginal delivery within a contemporary obstetric cohort. STUDY DESIGN Retrospective case-control study. PPH was classified by an estimated blood loss ⩾500 ml. Risk factors for PPH were identified using univariable and multivariable logistic regression. We secondarily investigated maternal outcomes and medical and surgical interventions for PPH management. RESULTS The study cohort comprised 159 cases and 318 controls. Compared with a second-stage duration <2 h, a second stage⩾3 h was associated with PPH (adjusted odds ratio=2.3; 95% CI=1.2 to 4.6). No other clinical or obstetric variables were identified as independent risk factors for PPH. Among cases, 4% received red blood cells and 1% required intensive care admission. CONCLUSION Although PPH-related morbidity may be uncommon after vaginal delivery, PPH should be anticipated for women after a second stage ⩾3 h.
Collapse
|
31
|
Hawke L, Grabell J, Sim W, Thibeault L, Muir E, Hopman W, Smith G, James P. Obstetric bleeding among women with inherited bleeding disorders: a retrospective study. Haemophilia 2016; 22:906-911. [PMID: 27704714 DOI: 10.1111/hae.13067] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Women with inherited bleeding disorders are at increased risk for bleeding complications during pregnancy and the postpartum period, particularly postpartum haemorrhage (PPH). AIM This retrospective study evaluates pregnancy management through the Inherited Bleeding Disorders Clinic of Southeastern Ontario, the clinical factors associated with pregnancy-related abnormal bleeding and assesses tranexamic acid use in the postpartum treatment of bleeding disorder patients. METHODS A chart review of 62 pregnancies, from 33 women, evaluated patient characteristics (age, haemostatic factor levels) and delivery conditions (mode of delivery, postpartum treatment) in relation to abnormal postpartum bleeding. RESULTS This cohort revealed increased risk of immediate PPH with increased age at delivery (mean age: 30.1 years with PPH, 26.5 years without PPH, P < 0.013), and birth by vaginal delivery (P < 0.042). Low von Willebrand factor (VWF) antigen or factor VIII (FVIII) in the third trimester was not associated with an increased risk of PPH; however, low VWF:RCo was associated with increased immediate PPH despite treatment with continuous factor infusion (P < 0.042). Women treated with tranexamic acid postpartum had less severe bleeding in the 6-week postpartum (P < 0.049) with no thrombotic complications. CONCLUSIONS This study contributes to the growing body of work aimed at optimizing management of bleeding disorder patients through pregnancy and the postpartum period, showing patients are at a higher risk of PPH as they age. Risk factors such as low third trimester VWF:RCo have been identified. Treatment with tranexamic acid in the postpartum period is associated with a reduced incidence of abnormal postpartum bleeding.
Collapse
Affiliation(s)
- L Hawke
- Queen's University, Kingston, ON, Canada
| | - J Grabell
- Queen's University, Kingston, ON, Canada
| | - W Sim
- Queen's University, Kingston, ON, Canada
| | - L Thibeault
- Kingston General Hospital, Kingston, ON, Canada
| | - E Muir
- Queen's University, Kingston, ON, Canada
| | - W Hopman
- Queen's University, Kingston, ON, Canada
| | - G Smith
- Queen's University, Kingston, ON, Canada
| | - P James
- Queen's University, Kingston, ON, Canada.,Kingston General Hospital, Kingston, ON, Canada
| |
Collapse
|
32
|
Schierding W, O'Sullivan JM, Derraik JGB, Cutfield WS. Genes and post-term birth: late for delivery. BMC Res Notes 2014; 7:720. [PMID: 25316301 PMCID: PMC4203931 DOI: 10.1186/1756-0500-7-720] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 09/29/2014] [Indexed: 12/13/2022] Open
Abstract
Background Recent evidence suggests that prolonged pregnancies beyond 42 weeks of gestation (post-term births) are associated with long-term adverse health outcomes in the offspring. Discussion There is evidence that post-term birth has not only environmental causes, but also significant heritability, suggesting genetic and/or epigenetic influences interact with environmental cues to affect gestational length. Summary As prolonged gestation is associated with adverse short- and long-term outcomes in the offspring, further research into the underlying genetic and epigenetic causes of post-term birth could be of importance for improving obstetric management.
Collapse
Affiliation(s)
| | | | | | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| |
Collapse
|