Abstract
BackgroundWe aimed to evaluate the incidence of undiagnosed abnormal postpartum blood loss (UPPBL) after vaginal delivery, identify the risk factors and compare them to those of postpartum haemorrhage (PPH).MethodThe study population included women who participated in a randomized controlled trial of women with singleton low-risk pregnancy who delivered vaginally after 35 weeks’ gestation (n = 3917). Clinical PPH was defined as postpartum blood loss ≥ 500 mL measured by using a collector bag and UPPBL was defined by a peripartum change in haemoglobin ≥ 2 g/dL in the absence of clinical PPH. Risk factors were assessed by multivariate multinomial logistic regression.ResultsThe incidence of UPPBL and PPH was 11.2% and 11.0% of vaginal deliveries, respectively. The median peripartum change in Hb level was comparable between UPPBL and PPH groups (2.5 g/dL interquartile range [2.2–3.0] and 2.4 g/dL IQR [1.5–3.3]). Risk factors specifically associated with UPPBL were Asian geographical origin (adjusted OR [aOR] 2.3, 95% confidence interval [CI] 1.2–4.2; p = 0.009), previous caesarean section (aOR 3.4, 2.1–5.5; p<0.001) and episiotomy (aOR 2.6, 1.8–3.6; p<0.001). Risk factors for both UPPBL and PPH were primiparity, long duration of labour, instrumental delivery and retained placenta.ConclusionUndiagnosed abnormal postpartum blood loss is frequent among women giving birth vaginally and has specific risk factors. The clinical importance of this entity needs further confirmation, and the benefit of systematic or targeted prevention strategies needs to be assessed.
Highlights
Postpartum haemorrhage (PPH) is defined by blood loss ! 500 mL within 24 hours after delivery[1]
We aimed to evaluate the incidence of undiagnosed abnormal postpartum blood loss (UPPBL) after vaginal delivery, identify the risk factors and compare them to those of postpartum haemorrhage (PPH)
Risk factors associated with UPPBL were Asian geographical origin, previous caesarean section and episiotomy
Summary
Postpartum haemorrhage (PPH) is defined by blood loss ! 500 mL within 24 hours after delivery[1]. 500 mL, no PPH has been diagnosed clinically, with reported incidences as high as 13% [5,6] This undiagnosed abnormal postpartum blood loss (UPPBL) has potential adverse consequences that could justify investigating their incidence and risk factors. Women with untreated postpartum anaemia, even moderate, experience more breathlessness, heart palpitations, fatigue and infections [11] and are at increased risk of maternal stress, anxiety, emotional instability, postpartum depression and reduced cognitive performance [7,8,9,10] than women without anaemia, up to 9 months after delivery In addition to these consequences on maternal health, postpartum anaemia affects mother–child interactions, compromises the mother–child bond and is associated with impaired infant development at 9 months of age [10]. We aimed to evaluate the incidence of undiagnosed abnormal postpartum blood loss (UPPBL) after vaginal delivery, identify the risk factors and compare them to those of postpartum haemorrhage (PPH)
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