Postpartum Anemia Research Articles

The definition, screening, and treatment of postpartum anemia: A systematic review of guidelines.

Postpartum anemia can negatively affect maternal health and interfere with early parenting. Thus, it is important to have clear, evidence-informed recommendations on its diagnosis and treatment. To compare global recommendations regarding the appropriate management of postpartum anemia and to highlight similarities and differences. Systematic searches were conducted in the databases PubMed, CINAHL, LILACS, TRIP database, and Scopus, and in the websites of health institutions and scientific societies. Search terms were related to anemia and the postpartum period. Two hundred and eighty papers were identified; the full texts of 30 sets of guidelines were reviewed, with seven being included in the final analysis. Recommendations were extracted through an evaluation of the evidence on the definition, screening, and diagnosis of anemia. The quality of the guidelines was assessed using the AGREE II instrument. Two sets of guidelines have been elaborated by international organizations, and the rest were produced by professional associations within high-resource countries. The discrepancies found in the guidelines are important and affect the definition of anemia, the criteria for screening asymptomatic women, or the criteria guiding treatment. The quality of the guidelines commonly scored between 4 and 6 on a scale of 0 to 7. Recommendations with poor-quality evidence predominated over recommendations with high-quality evidence. This review highlights the need to reach a consensus on the definition of postpartum anemia, to agree on what constitutes a problem for maternal health, and to provide recommendations that reach greater consensus on its diagnosis and treatment.

Relationship between patient ethnicity and prevalence of anemia during pregnancy and the puerperium period and compliance with healthcare recommendations - implications for targeted health policy

BackgroundAnemia is common during pregnancy and the puerperium. The association of ethnicity as well as other characteristics with anemia and compliance with healthcare recommendations has not been studied sufficiently and needs to be explored in order to implement a targeted health policy. We examined the association between ethnicity and the risk for prenatal and puerperium anemia and the compliance with healthcare recommendations. This effort aims to guide reforms in policies and practices that will assist in decreasing anemia prevalence in Israel.MethodsThis study was a secondary analysis of a prospective cohort study database including 1558 women who delivered vaginally at Emek Medical Center. Anemia was assessed before delivery by obtaining a complete blood count (CBC). After delivery, CBCs were taken in cases of postpartum hemorrhage, symptoms consistent with anemia, prenatal anemia or other clinical indications. The study population was divided according to their ethnicity (Jews and Arabs).The primary outcomes were anemia before delivery, anemia in the immediate postpartum and 6 weeks postpartum, and compliance with healthcare recommendations, which was defined as the rate of women who performed a routine CBC test 6-weeks-postpartum.ResultsThe rates of anemia before delivery and in the puerperium period were similar between Jews and Arabs (before delivery: 88 (11%) versus 98 (14%); 6 weeks postpartum: 55 (21%) vs 68 (28%), respectively;p > 0.05). Iron supplementation was high in both groups during pregnancy (~ 90%) and lower during the postpartum for Jews compared to Arabs (72% vs 83%,respectively; P < .0001). Only one third of the patients performed a CBC 6-weeks-postpartum regardless of ethnicity.ConclusionOverall compliance with health recommendation was high during pregnancy but low postpartum and was reflected in anemia persistence regardless of ethnicity.Because of the adverse long term impact of anemia on patient’s health, new policies need to be developed to improve patient’s compliance postpartum. A possible strategy is to combine the follow-up of the mother with the one of the newborn in the family health stations (Tipat Halav) and the community clinics similarly to the close follow-up during pregnancy. Additional methods may include active summoning for CBC test and assuring iron supplement consumption.

Characteristics and Early Outcomes of Forceps Deliveries in a Tertiary Clinical Center

O bjective - The study aimed to investigate the characteristics of women and their children as well as the deliveries completed us- ing forceps in one tertiary center. M aterial and Methods - The study included all women who had vaginal delivery during 2019. Women were classified according to use of the outlet forceps for delivery into the study and control group. We recorded maternal age and parity, duration of delivery, stimulation and epidural analgesia use, neonatal measures and Apgar score, maternal and neonatal complications after delivery. R esults - Of the 3,570 vaginal births, forceps was applied 23 (0.64%) times. Most women were aged <35 years and were primiparous. The indication for forceps use in all cases was the delay in the expulsion phase. Forceps deliveries lasted on average 6.20+/-2.15 hours. In both groups, birth canal injuries were frequently registered (P=0.001), while uterine atony was rare (P=0.001). Postpartum anemia was more frequent after forceps application, however, not significantly. A similar number of children with and without neonatal complications was registered (P=0.140). Children born using forceps had lower Apgar scores than those from the control group (P=0.046) and spent longer time in the intensive care unit (P=0.038). There were no other significant differences in any of the tested parameters of mothers and children between the study and the control group. Conclusion - Use of forceps is remarkably rare in our setting. Children born using forceps have less favorable early perinatal outcomes, but few serious long-term complications. If applied skillfully and according to indications, forceps is safe for both mothers and children.

PENGARUH SARI KACANG HIJAU TERHADAP KADAR HEMOGLOBIN IBU NIFAS

Postpartum anemia is caused due to insufficient iron supplementation and excessive bleeding during or after delivery. The initial survey found that there were 5 mothers who had anemia. This study aims to determine the effect of mung bean juice on hemoglobin levels in postpartum mothers, by using quantitative research. The population in this study were all 12 postpartum mothers in the first week. The sampling technique used is total sampling. Data collection was done by using observation. The average Hb level before being given green bean juice was 12.74 gr / dL and after that was 12.75 gr / dL. The difference in mean Hb levels before and after giving green bean juice was 0.008 gr / dL. The results of statistical tests using paired sample t-test (CI: 95%) obtained ρ value of 0.972, so it can be concluded that there is no effect of mung bean juice on hemoglobin levels of postpartum mothers. For postpartum mothers to be more proactive in seeking information about anemia, as well as finding out the benefits of green bean juice.

Study protocol of a cluster randomized controlled trial of strategies to increase antenatal iron and folic acid supplementation and malaria prophylaxis in rural south-central C\xf4te d\u2019Ivoire

BackgroundCoverage of antenatal iron and folic acid supplementation (IFAS) and intermittent preventive treatment of malaria in pregnancy (IPTp) remains low in many countries. Evidence on the most effective ways to increase both IFASIPTp is mixed overall, with only few studies directly identifying cost-effective ways to increase coverage of both interventions. The proposed study aims to assess the cost, impact and relative cost-effectiveness of two complementary strategies of increasing IFAS and malaria chemoprophylaxis coverage among pregnant women relative to the current default system in a rural low-income setting of sub-Saharan Africa.Methods/designThis study will be carried out in the Taabo health and demographic surveillance system (HDSS) in south-central Côte d’Ivoire. This is a cluster-randomized trial targeting 720 consenting pregnant women aged ≥15 years. The 118 clusters constituting the Taabo HDSS monitoring area will be randomly allocated to one of the following three groups with equal probability: a control group, an information only group, and an information plus home delivery group. To assess the relative effectiveness of each strategy, we will conduct an endline survey within the first 2 weeks after delivery. The primary outcomes of the trial will be maternal post-partum anaemia and malaria infection. Anaemia will be assessed using HEMOCUE devices; malaria infections will be assessed using standard rapid diagnostic tests named CareStart™ Malaria Pf (HRP2) Ag RDT (Multi Kit with capped lancet and inverted cup specimen transfer device). Other outcomes will include self-reported adherence to supplementation and malaria chemoprophylaxis, as well as miscarriages, stillbirths and low birth weight deliveries.DiscussionThis study will assess the cost-effectiveness of two alternative strategies to increase antenatal IFAS and malaria chemoprophylaxis coverage among pregnant women in rural Côte d’Ivoire and similar settings.Trial registrationClinicalTrials.govNCT04250428; Registered 31 January 2020.

Routine correction disadvantages of iron deficiency anemia in pregnant women, women in labor and puerperas (a retrospective study based at the State Budgetary Healthcare Institution of Nizhny Novgorod Region “Dzerzhinsk Perinatal Center”)

Introduction. Iron deficiency (ID) is in almost 90% of pregnant woman by the third trimester, persisting in 55% of cases after childbirth. This study aims identification of deficiencies in the routine diagnostics and correction of iron deficiency anemia (IDA) in pregnant women, women in labor and postpartum. Methods . the study included 150 pregnant women from 18 to 43 years old, in whom iron therapy during pregnancy and the postpartum period analyzed in a complex of blood-saving technologies. Results. Serum ferritin (SF) detected only in 45% of pregnant women with anemia. In the first trimester, mild anemia diagnosed in 10% of women, moderate - in 0.6%; in the second trimester - in 47.3% and 1.2%, respectively. In the third trimester, mild anemia was in 94% of patients, moderate - in 4%. Correction of IDA in 94% of cases carried out with oral iron. In the postpartum period, all women have IDA: mild anemia in 82.7%, moderate in 15.3%, severe in 2% of cases. Mild anemia treated with oral iron, moderate - with intravenous iron in 61%, in other cases used oral iron. Conclusion. An increased severity of IDA before childbirth, in spite of it’s correction during pregnancy; it is necessary to diagnose anemia by SF in all pregnant women, with an assessment of the oral iron therapy response by hemoglobin and tolerance; in the absence of a result, intravenous non-dextran iron is indicated in the required calculated dose. Complex correction of obstetric blood loss and postpartum anemia by autoerythrocytes, blood coagulation factors and rational IDA therapy with non-dextran high-dose intravenous iron will allow us to implement restricting approach of the use of donor blood components.

Risk factors for postpartum depression: An evidence-based systematic review of systematic reviews and meta-analyses.

Postpartum depression (PPD) is the most common psychiatric condition after childbirth which not only effects the mother's health, but also might have impact on child's development and parenting behaviors. Because the etiology of PPD has not been fully cleared, the efforts towards identification of risk factors are crucial for both the children and mother's health. PubMed, EMBASE and PsycINFO databases were searched since inception until July 2019 to collect data about the risk factors of PPD and only systematic review and meta-analysis can be included. To identify the real risk factors, protective factors and controversial factors, nineteen parts of the interpretation were adopted. The risk factors are mainly concentrated in the following aspects: violence and abuse, immigration status, gestational diabetes, cesarean section, depressive history, vitamin D deficiency, obese and overweight, postpartum sleep disruption and poor postpartum sleep, lack of social support, traditional dietary pattern (Japanese, Indian, United Kingdom, and Brazilian dietary pattern), multiple births, preterm and low-birth-weight infants, postpartum anemia, negative birth experience. The controversial factors are serum level of cortisol, thyroid peroxidase autoantibodies status, acculturation, traditional confinement practices. Skin-to-skin care, higher concentrations of DHA in mothers' milk, greater seafood consumption, healthy dietary patterns, multivitamin supplementation, fish and PUFA intake, calcium, Vitamin D, zinc and possibly selenium are protective factors. Thirteen risk factors were identified, but five factors still controversial due to the insufficient of the evidence. What's more, skin-to-skin care and some nutrition related factors are protective factors against PPD.

Prevalence and Risk Factors of Iron Deficiency Anemia among Postpartum Women

One of the problems that contributes to the highest number of maternal mortality and morbidity is postpartum anemia. It is estimated that 50–80% of women experience anemia within 48 hours after giving birth. Globally, the commonest cause of anemia is iron deficiency. In Aceh, study on anemia in the postpartum period is still rare and requires to get more attention. This study aims to identify the prevalence of anemia among postpartum women and the associated risk factors that influence the incidence of postpartum iron deficiency anemia. This study is a quantitative study with a cross-sectional study design conducted at dr. Zainoel Abidin Hospital. Participants in this study were recruited using a non-probability sampling method and obtained 102 participants. Data were analyzed using chi-square tests with a confidence level of 95%. This study showed that 49.0% of the postpartum women had mild anemia, 10.8% of them had moderate anemia, and another 40.2% do not have anemia. It is found that there is a significant relationship between obstetric factors (type of labor, delivery complications) with anemia among anemia postpartum mothers ( .014 and .047 respectively).

Single-unit vs multiple-unit transfusion in hemodynamically stable postpartum anemia: a pragmatic randomized controlled trial

The American Academy of Blood Banks recommends single-unit red cell transfusion protocols across medicine to reduce transfusion complications and the use of a scarce resource. There are minimal data regarding single-unit protocols in obstetrics. We aimed to compare single-unit vs multiple-unit transfusion protocols for treatment of hemodynamically stable postpartum anemia. We performed a randomized trial comparing initial transfusion with 1 unit of packed red blood cells (single-unit protocol) to 2 units of packed red blood cells (multiple-unit protocol) from March 2018 to July 2019. Women who required transfusion >6 hours postpartum were approached for consent. Unstable vital signs, hemoglobin level <5 g/dL, hemoglobinopathy, and cardiomyopathy were exclusion criteria for enrollment. Hemoglobin assessment and standardized clinical evaluation were performed 4 to 6 hours posttransfusion; additional packed red blood cells were given if indicated. The primary outcome was total units transfused. Secondary outcomes included length of stay, endometritis, wound separation or infection, venous thromboembolism, and intensive care unit admission within 30 days postpartum. Breastfeeding, depression, maternal attachment, and fatigue scores were assessed at 4 to 9 weeks postpartum. A total of 66 women were required to detect a 20% reduction in units transfused with a single-unit protocol (power=80%; α=0.05). A total of 66 women were randomized (33 per arm). There were no differences between groups in demographic or clinical characteristics, including delivery mode, blood loss, and randomization hemoglobin levels. The mean number of units transfused was lower in the single-unit protocol than in the multiple-unit protocol (1.2 U vs 2.1 U; P<.001). Only 18.2% of women in the single-unit arm required additional packed red blood cells. At posttransfusion assessment, women in the single-unit arm had lower hemoglobin levels (7.8 g/dL vs 8.7 g/dL; P<.001), but there were no differences in vital signs or symptoms between groups. There were also no differences in length of stay, 30-day complications, or 4 to 9 week postpartum outcomes. In women with hemodynamically stable postpartum anemia, a single-unit protocol avoided a second unit of packed red blood cells in >80% of women without significant impact on morbidity. Our work supports the use of single-unit initial transfusion in this population.

Proportion of Immediate Postpartum Anaemia and Associated Factors among Postnatal Mothers in Northwest Ethiopia: A Cross-Sectional Study.

Background Anaemia is a major global health problem, especially in developing countries. Postpartum anaemia hurts both maternal and newborn baby health. Anaemia in pregnancy is sufficiently emphasized; however, very little attention has been paid to postpartum anaemia in Ethiopia. Therefore, this study aimed to investigate the proportion of immediate postpartum anaemia and associated factors among postpartum mothers in Debre Markos Referral Hospital. Methods Institutional-based cross-sectional study was conducted among 424 study participants from August 1st to October 30th, 2019. A systematic random sampling technique was employed to select the study participants. Data were collected through both face-to-face interview and maternal chart review by using a pretested questionnaire. Data were cleaned, coded, and entered using Epi Data version 4.6.0.0 and then exported to SPSS version 24 for analysis. First, binary logistic regression was applied to identify candidate variables for multivariable regression. Then, variables at p value <0.2 were entered into a multivariable logistic regression to control possible confounders. Finally, variables at p value <0.05 were considered as statistically significant. Results The proportion of immediate postpartum anaemia was 24.3%. Frequency of antenatal care (ANC) visits <4 times [AOR = 2.40; 95% CI (1.29, 4.43)], antepartum haemorrhage (APH) [AOR = 5.08; 95% CI (1.91, 13.55)], postpartum haemorrhage (PPH) [AOR = 4.47; 95% CI (2.25, 8.88)], giving birth assisted by instruments (vacuum or forceps) [AOR = 3.99; 95% CI (1.42, 11.23)], poor adherence to iron and folic acid (IFA) [AOR = 2.52; 95% CI (1.06, 6.04)], and midupper arm circumference (MUAC) <23 cm [AOR = 3.25; 95% CI (1.87, 5.65)] were the predictors. Conclusion The proportion of immediate postpartum anaemia was a moderate public health concern. ANC, APH, PPH, mode of delivery, adherence to IFA supplementation, and MUAC measurement were the factors affecting the magnitude of anaemia. Therefore, interventions that would address the above mentioned factors need to be implemented.

Oral Versus Intravenous Iron Therapy for Postpartum Anemia: A Systematic Review and Meta-analysis

(Am J Obstet Gynecol. 2019;19.e2–29.e2) Postpartum anemia is associated with fatigue, depression, and impaired cognition. Postpartum anemia affects up to 50% of women in well-resourced countries and up to 80% of women in developing countries, which can affect maternal-child bonding. However, adverse gastrointestinal reactions to oral iron treatments (ie, nausea, vomiting, and constipation) occur in up to 40% of patients, resulting in poor compliance and persistent anemia. Intravenous (IV) iron may be ideal for these patients, as it mitigates the absorption challenges and produces a more rapid increase in hemoglobin (Hb) concentration and iron stores. The disadvantages of IV iron include increased cost and the need for treatment at a hospital or outpatient facility. This study was an updated systematic review of all randomized trials comparing oral versus IV iron therapy to treat postpartum anemia. The primary outcome measure was postpartum Hb.

Prevalence and Associated Risk Factors of Immediate Postpartum Anemia in Two Teaching Hospitals in Mekelle

Background: Anemia is a major global health problem this fundamental health issue still has not been solved and continues to exist affecting the health, quality of life, and working capacity in billions of people all over the world. It has been estimated that of the 500,000 maternal deaths occurring each year on a global scale in association with delivery, 20% are caused by peripartum hemorrhage and anemia. The frequency of postpartum anemia is poorly elucidated. The performance of postpartum hematocrit measurements after vaginal delivery to identify patients who are anemic is not practiced in our facility; so this research will help as to know the disease burden and also the most common associated factors. Objectives: Determine the prevalence and associated risk factors of immediate postpartum anemia in teaching hospitals, Northern Ethiopia. Methods: A facility based cross-sectional survey was employed in teaching hospitals in northern Ethiopia. A random sample of 236 postpartum women were included in the study. Socio-demographic and risk factors associated with postpartum anemia were collected by a standardized questionnaire. Blood samples were collected and processed using the standard procedures for hemoglobin determination. The samples were assessed for prevalence and associated factors for immediate postpartum anemia. A p-value &lt;0.05 was considered significant in bivariate analysis. Variables which are found significant at bivariate analysis were analyzed by multivariate analysis. Then the final predictor was generalized by Odds ratio [OR] and 95% CI. Result: All 236 women participated in the study making the overall response rate 100%. Almost half 120 (50.8%) of the respondents are urban dwellers and 26(11%) were unable to read and write. The prevalence of immediate postpartum anemia in this study was 24.2%. There was significant association on multivariate analysis that the woman who came from rural areas are 66% less likely to develop postpartum anemia (AOR=0.34 and CI=0.118, 0.998); Mothers who are unable to read and write were 14.4 times more likely to have postpartum anemia (AOR=14.4 and 95% CI=2.27, 91.14); women who have estimated blood loss of less than 500 ml during delivery are 90.5% less likely to have postpartum anemia (AOR= 0.095 and CI=0.018,0.513);the mothers who deliver vaginally are 87% less likely to have immediate postpartum anemia (AOR=0.13 and CI=0.038, 0.454); mothers who are diagnosed to have PPH on clinical grounds were 7.4 times more likely to have immediate postpartum anemia (AOR=7.43 and CI=1.46, 37.79). Conclusion and recommendation: The results from this study shows that the prevalence of postpartum anemia is high and shows there is a significant number of women who have postpartum anemia after vaginal delivery which will be missed with the current protocol that we are using.

Neonatal and Maternal Complications of Placenta Praevia and Its Risk Factors in Tikur Anbessa Specialized and Gandhi Memorial Hospitals: Unmatched Case-Control Study.

Background Placenta praevia is a disorder that happens during pregnancy when the placenta is abnormally placed in the lower uterine segment, which at times covers the cervix. The incidence of placenta praevia is 3-5 per 1000 pregnancies worldwide and is still rising because of increasing caesarean section rates. Objective To assess and identify the risk factors and maternal and neonatal complications associated with placenta praevia. Method and Materials. Target populations for this study were all women diagnosed with placenta praevia transvaginally or transabdominally either during the second and third trimesters of pregnancy or intraoperatively in Tikur Anbessa Specialized and Gandhi Memorial Hospitals. The study design was unmatched case-control study. Data was carefully extracted from medical records, reviewed, and analyzed. Unconditional logistic regression analysis was performed using adjusted odds ratios (AOR) with 95% confidence intervals. Results Pregnancies complicated by placenta praevia were 303. Six neonatal deaths were recorded in this study. The magnitude of placenta praevia observed was 0.7%. Advanced maternal age (≥35) (AOR 6.3; 95% CI: 3.20, 12.51), multiparity (AOR 2.2; 95% CI: 1.46, 3.46), and previous history of caesarean section (AOR 2.7; 95% CI: 1.64, 4.58) had an increased odds of placenta praevia. Postpartum anemia (AOR 14.6; 95% CI: 6.48, 32.87) and blood transfusion 1-3 units (AOR 2.7; 95% CI: 1.10, 6.53) were major maternal complications associated with placenta praevia. Neonates born to women with placenta praevia were at increased risk of respiratory syndrome (AOR 4; 95% CI: 1.24, 13.85), IUGR (AOR 6.3; 95% CI: 1.79, 22.38), and preterm birth (AOR 8; 95% CI: 4.91, 12.90). Conclusion Advanced maternal age, multiparity, and previous histories of caesarean section were significantly associated risk factors of placenta praevia. Adverse maternal outcomes associated with placenta praevia were postpartum anemia and the need for blood transfusion. Neonates born from placenta praevia women were also at risk of being born preterm, intrauterine growth restriction, and respiratory distress syndrome.

Uterine exteriorization versus In situ repair of the uterine incision at cesarean delivery

Background: Opinion appears divided on uterine exteriorization for uterine repair at Cesarean delivery. The available evidence appears insufficient to aid policy pronouncement of routine uterine exteriorization for repair of the lower segment incision. Aim: To evaluate the effect of extra-abdominal versus intra-abdominal repair of the uterine incision at Cesarean delivery. Materials and Methods: One hundred and seventy women were randomly assigned to groups; Group “A” had their repairs after exteriorization while Group “B” had in situ repair. It compared the effects of exteriorization of the uterus and in situ repair during Cesarean delivery. Outcome measures included: Intraoperative blood loss, postpartum anemia, transfusion rate, mean operative time, postoperative wound infection rate, nausea and vomiting, The data were analyzed using Statistical Package for the Social Sciences, version 20. Results: A data were available for analysis in 169 women that completed the study (exteriorization group [n = 85] and in situ repair group [n = 84]).Except for the statistically higher incidence of nausea/vomiting among the women that had exteriorization when compared with their counterpart whose uteri were repaired in situ(10.6% vs. 2.4%; P = 0.031). There were no statistically significant differences between the two groups in terms of the mean preoperative hematocrit (34.8% vs. 35.7%), P = 0.830; the mean postoperative hematocrit level (30.8 ± 4.7 vs. 30.8 ± 4.9), P = 0.958; the mean estimated blood loss (575 ml vs. 577 ml), P = 0.942; the postpartum anemia (35.3% vs. 26.2%), P = 0.200; transfusion rate was (15.3% vs. 17.9%), P = 0.518; operation time (57.5 vs. 53.2 min), and the surgical site infection rate (1.2% vs. 1.2%), P = 0.993. Conclusion: Exteriorization and in situ repair of uterine incisions had similar outcome but, the former is associated with significant higher incidence of nausea/vomiting.

Effectiveness of intravenous ferric carboxymaltose in improving hemoglobin level among postpartum women with moderate-to-severe anemia at a secondary care hospital in Faridabad, Haryana - An interventional study.

Postpartum anemia is associated with postpartum anxiety, depression, poor cognitive interaction, and delayed infant development. Oral iron is the currently recommended therapy but is associated with gastrointestinal complaints and poor compliance. Parenteral iron dextran may cause serious side effects, whereas iron sucrose requires repeated visits. Intravenous ferric carboxymaltose (FCM) is given as an infusion in a single setting, which is logistically convenient both to patients and health system. It can be particularly beneficial for postpartum women who are usually discharged from health facility 48 h after delivery. The objectives of this study were to estimate the change in mean hemoglobin (Hb) level 6 weeks after administration of intravenous FCM and to document any adverse events following administration among postpartum women. A prospective, interventional follow-up study was conducted from August to December 2018. One hundred eligible postpartum women with Hb level of 5-9.9 g/dl were administered a calculated dose of intravenous FCM based on Ganzoni's formula with Hb target of 12 g/dl. Hb and serum ferritin were measured at baseline and at 6 weeks after FCM infusion and compared for mean increase. There was a significant increase in Hb and serum ferritin levels after administration of FCM. The mean (95% confidence interval) increase in the Hb and serum ferritin after 6 weeks was 4.2 (3.9-4.5) g/dl and 137.3 (113.6-161.0) ng/ml, respectively. No major adverse events were reported. Administration of FCM was safe and effective in the treatment of moderate-to-severe anemia among postpartum women.

Hot topics in obstetric anesthesia

In 2019 the annual conference of the scientific working group on obstetric anesthesiology of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) took place in the usual manner. Emergency situations, such as the challenge of a preclinical birth or the recognition and treatment of an amniotic fluid embolism were discussed. In addition, topics on the correct treatment of a female patient with a known addictive disorder were of great interest as well as the discussion on the question when a transfusion should be performed in postpartum anemia and which risks accompany the increasing prevalence of obesity, especially during pregnancy. A further hot topic was the deliberation on the prevalence and differential diagnostic clarification of neurological complications after epidural anesthesia. In connection with the topic of birth, exciting and practice relevant topics for all anesthetists confronted with this field were presented and discussed. The essential aspects are summarized in this article.

Intravenous Versus Oral Iron Therapy for Postpartum Anemia

Postpartum iron deficiency anemia (IDA) is a common problem throughout the world. Various treatment modalities like oral iron therapy, parenteral iron therapy and blood transfusion are used to treat anemia in the postpartum period. This study aimed to compare efficacy, safety, tolerability and side effects of treatment with either intravenous iron sucrose or oral ferrous gluconate for postpartum iron deficiency anemia to ascertain whether administering intravenous iron sucrose to women with postpartum anemia results in higher hemoglobin concentration and improved iron stores than using standard treatment with oral iron. This comparative, randomized and prospective study conducted in Obstetrics and Gynecology Department of Benha University Hospital and Benha Teaching Hospital in the period from 1/11/2018 to 30/9/2019. This study was carried on 60 women with postpartum iron deficiency anemia. The inclusion criteria was hemoglobin concentration

261: SMaRTBlood: randomized, controlled trial of Single- versus Multiple-unit Red cell Transfusion for non-acute postpartum anemia

The American Academy of Blood Banks recommends single-unit red cell transfusion protocols across medicine to reduce complications and use of a scarce resource, without evidence specific to obstetrics. We aimed to compare a single- vs. multiple-unit transfusion protocol for non-acute postpartum anemia. We performed a randomized trial comparing initial transfusion with 1 unit of packed red blood cells [pRBCs] (single-unit protocol) to 2 units of pRBCs (multiple-unit protocol) from 3/2018-7/2019. Women >6 hours from delivery determined to require transfusion were approached for consent. Unstable vital signs, hemoglobin(Hb)< 5g/dL, hemoglobinopathy, and cardiomyopathy were enrollment exclusions. Block randomization occurred 1:1. Post-transfusion, a 4-6 hour Hb and standardized clinical evaluation were performed; additional pRBCs were then given if indicated. Breastfeeding, depression, maternal attachment, and fatigue scores were assessed at 4-9 weeks postpartum. The primary outcome was total units transfused. 66 women were required to detect a 20% reduction in units transfused with a single-unit protocol (power=80%; α=0.05). 66 women were randomized (33/arm). There were no differences between groups in demographic or clinical characteristics, including delivery mode, blood loss, and randomization Hb. Mean number of units transfused was lower in the single- compared to the multiple-unit protocol (1.2u vs. 2.1u, p< 0.001). Only 18.2% of women in the single-unit arm required additional pRBCs (Figure). At post-transfusion assessment, women in the single-unit arm had lower Hb (7.8g/dL vs. 8.7g/dL, p< 0.001), but there were no differences in vital signs or symptoms between groups. There were also no differences in length of stay, 30-day complications, or 4-9 week postpartum outcomes (Table). With a single-unit protocol, a second unit of pRBCs can be avoided in >80% of postpartum women requiring non-acute transfusion without significant impact on short-term or post-discharge morbidity. Our work supports single-unit initial transfusion as standard of care in this population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Evaluation of Post-Partum Anemia and Its Risk Factors and Treatment

Iron deficiency anemia (IDA) in pregnancy, i.e., prepartum anemia, is associated with premature birth, low birth weight, and small for gestational age of the newborn and is furthermore closely associated with the occurrence of anemia after delivery of a child, i.e., in the postpartum period .Post-partum anemia is a common problem throughout the world. through this study aim of the work ( frequency of post-partum anemia and risk factors for its development) The study showed that percentage of antepartum anemia was about 64.3% this percentage postpartum increased to about 65.4% and 13.6% of those with antepartum normal hemoglobin level became anemic. The main causes of postpartum anemia are prepartum iron deficiency anemia in combination with excessive blood losses at delivery. Post-partum anemia is not affected by demographic data, obstetric history, ante-partum u/s finding and obstetric history. Antepartum bleeding was not significantly associated with postpartum anemia. The more the estimated blood loss during labor the more the postpartum anemia. Through follow up of post-partum anemia cases and treated it according type of anemia (oral, intravenous, folate supplementation and blood transfusion). Outcome of treatment of anemia after 8 weeks, 61.02 % was improved and 8.98 % was not improved, due to malabsorption or non-adherence to drug usage. Conclusion: The main causes of postpartum anemia in this study are prepartum iron deficiency anemia and the amount of blood loss at delivery. this study’s results suggest that screening of women with peri delivery Hb

The Relationship Between Blood Loss and Post-CD Hemoglobin (Hb), and Whether Their Correlation Varies According to Type of Measurement

(Anesth Analg. 2019;128(5):926–932) Although postpartum hemorrhage (PPH) is a strong independent risk factor for postpartum anemia following a cesarean delivery (CD), relatively little is known about the relationship between overall blood loss and post-CD hemoglobin (Hb) levels. This study investigated whether such a relationship could be used to predict postpartum anemia.