Risk Factors For Postpartum Hemorrhage Research Articles

Risk factors for obstetrical hemorrhage among nulliparous, term, singleton, vertex pregnancies

Postpartum hemorrhage (PPH) is an important cause of severe maternal morbidity. Current prediction models do not identify risk factors for PPH among low-risk pregnant patients. Our objective was to evaluate the labor course and identify factors associated with PPH among nulliparous, term, singleton, vertex patients (NTSV) to develop a nomogram to assess risk.

Частота встречаемости, основные факторы риска и эффективность лечения пациенток с послеродовыми кровотечениями

Aim: to evaluate the frequency of postpartum hemorrhage (PPH) in a high risk hospital, to conduct a comparative assessment of the clinical, historical and laboratory features of patients with PPH, and the effectiveness of the algorithm of PPH management after vaginal birth (VB) and caesarean section (CS). Design: retrospective study. Material and methods. The study included 15,480 patients. The frequency of early PPH and the effectiveness of applying a local stepwise algorithm for management of PPH were evaluated. Clinical historical and laboratory data were obtained by copying from the primary documentation. Results. The incidence of PPH in a high risk hospital is 0.67%. The most significant risk factor for PPH is the induction of labor, but more than a third of women do not have significant risk factors. The volume of blood loss after CS was 1218.29 ± 728.15 ml, after VB — 784.12 ± 304.44 ml (p<0.001). Uterine balloon tamponade was used in 28 (44.4%) women with PPH after VB and in 27 (65.9%) after CS (χ2 = 4.600; p = 0.142). Compression sutures on the uterus were used in 12 (29.3%) patients after CS and in 3 (2.9%) puerperas after VB (χ2 = 2.8; p = 0.001). Hysterectomy was performed in 4 (9.8%) cases only after CS. Conclusion: The existing algorithms for management PPH are highly effective and allow avoiding hysterectomy in VB in 100% of cases, in CS — in 90.2%. Keywords: postpartum hemorrhage, uterotonics, controlled balloon tamponade, complex compression haemostasis.

Tranexamic acid for the prevention of postpartum hemorrhage and decreasing blood loss after vaginal delivery in high-risky parturient: A double-blind randomized controlled trial

Background and objective: The purpose of this study was to examine the effectiveness of Tranexamic acid administered in the third stage of labor to reduce vaginal blood loss and prevent postpartum hemorrhage in women with high-risk factors for postpartum Hemorrhage. Methods: A double-blind randomized placebo-controlled trial with two parallel groups was conducted in women scheduled to undergo vaginal delivery at the Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq. The women were randomly assigned to receive tranexamic acid (97 women) or placebo (99 women) immediately after fetal delivery in the third stage of labor. The vaginal blood loss and the time from fetal to placental delivery were measured. Results: The mean blood loss in the placebo group (Group 1) was 354.5 gram, which was considerably greater than the mean blood loss in the tranexamic group (Group 2), which was 284.4 gram. The incidence of postpartum hemorrhage (blood loss of ≥500 ml.) and (blood loss of ≥250 ml.) was significantly higher in G1 than G2. The length of the third stage of labor lasted 10.28 minutes in G1, which was longer than in G2, which lasted 7.82 minutes. Oxytocin was given to both groups as an active management of the third stage of labor. Conclusion: In this single-center study, women with risk factors for postpartum hemorrhage who received tranexamic acid had lower postpartum blood loss and a shorter time for placental delivery than those women who received placebo. Larger multicenter randomized clinical trials are needed to generalize these findings.

Patient Blood Management programs for post-partum hemorrhage.

Patient blood management (PBM) strategies aim to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss to improve patient outcomes. Because postpartum hemorrhage (PPH) is a leading cause of maternal mortality and blood product utilization, PBM principles can be applied in its therapeutic approach. First, pre-operative identification of risk factors for PPH and identification of peri-delivery anemia should be conducted. Iron supplementation should be used to optimize hemoglobin concentration before delivery; it can also be used to treat anemia in the postpartum period after severe PPH. Both acute normovolemic hemodilution and intraoperative cell salvage can be effective techniques to reduce allogeneic blood transfusion during or after surgical procedures. Furthermore, these strategies appear to be safe when used in the pregnant population.

Postpartum Hemorrhage Trends and Outcomes in the United States, 2000-2019.

To analyze temporal trends in and risk factors for postpartum hemorrhage and to analyze the association of risk factors with postpartum hemorrhage-related interventions such as blood transfusion and peripartum hysterectomy. This repeated cross-sectional study analyzed delivery hospitalizations from 2000 to 2019 in the National (Nationwide) Inpatient Sample. Trends analyses were conducted using joinpoint regression to estimate the average annual percent change (AAPC) with 95% CIs. Unadjusted and adjusted survey-weighted logistic regression models were performed to evaluate the relationship between postpartum hemorrhage risk factors and likelihood of 1) postpartum hemorrhage, 2) postpartum hemorrhage that requires blood transfusion, and 3) peripartum hysterectomy in the setting of postpartum hemorrhage, with unadjusted odds ratios and adjusted odds ratios with 95% CIs as measures of association. Of an estimated 76.7 million delivery hospitalizations, 2.3 million (3.0%) were complicated by postpartum hemorrhage. From 2000 to 2019, the rate of postpartum hemorrhage increased from 2.7% to 4.3% (AAPC 2.6%, 94% CI 1.7-3.5%). Over the study period, the proportion of deliveries to individuals with at least one postpartum hemorrhage risk factor increased from 18.6% to 26.9% (AAPC 1.9%, 95% CI 1.7-2.0%). Among deliveries complicated by postpartum hemorrhage, blood transfusions increased from 5.4% to 16.7% from 2000 to 2011 and then decreased from 16.7% to 12.6% from 2011 to 2019. Peripartum hysterectomy among hospitalized individuals with postpartum hemorrhage increased from 1.4% to 2.4% from 2000 to 2009, did not change significantly from 2009 to 2016, and then decreased significantly from 2.1% to 0.9% from 2016 to 2019 (AAPC -27.0%, 95% CI -35.2% to -17.6%). Risk factors associated with postpartum hemorrhage and transfusion and hysterectomy in the setting of postpartum hemorrhage included prior cesarean delivery with previa or placenta accreta, placenta previa without prior cesarean delivery, and antepartum hemorrhage or placental abruption. Postpartum hemorrhage and related risk factors increased over a 20-year period. Despite the increased postpartum hemorrhage rates, blood transfusions, and hysterectomy rates decreased in recent years.

Hospital Characteristics and Other Factors Associated with the Risk of Postpartum Hemorrhage in the United States.

Background: Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality in the United States. It occurs when blood loss exceeds 1000mL regardless of the delivery route. Careful assessment of various causes and risk factors of PPH is essential to reduce and prevent further complications, avoid maternal morbidity and mortality, and better manage PPH. This study aimed to examine the associations of hospital characteristics and regions of hospital locations across the United States with PPH risk, as the outcomes of such an assessment may contribute to practice-relevant scientific evidence to improve policies and protocols regarding effective PPH management. Methods: This retrospective study used the 2018 National Inpatient Sample database from the Healthcare Cost and Utilization Project (HCUP) to examine the associations of PPH risk with characteristics and regions of hospital lections. Results: After controlling for clinical risk factors, the results showed that hospitals owned by private investors had significant associations with decreased risk of PPH. Conversely, large bed size, urban teaching status, and West and Midwest location were associated with an increased risk of PPH. Conclusion: Additional research is needed to determine whether these variations across regions and hospital characteristics are due to differences in obstetric practice and management.

Outcomes for women admitted for labour care to alongside midwifery units in the UK following a postpartum haemorrhage in a previous pregnancy: A national population-based cohort and nested case-control study using the UK Midwifery Study System (UKMidSS)

BackgroundWomen who have experienced a postpartum haemorrhage (PPH) ‘requiring treatment or transfusion’ are typically advised to plan birth in obstetric-led settings in subsequent pregnancies. Many UK alongside midwifery units (AMU) admit women for labour care following a previous PPH. We aimed to describe outcomes in women admitted for labour care to AMUs following a previous PPH, compare outcomes with other multiparous women admitted to the same AMUs, and explore risk factors for recurrence. MethodsA national cohort and nested case-control study using the UK Midwifery Study System (UKMidSS), between August 2018 and April 2019. Multivariable Poisson regression and logistic regression were performed to compare outcomes and investigate risk factors for recurrence. FindingsWomen who experienced a previous PPH were significantly more likely than comparison women to: have a PPH requiring transfer to obstetric care (4·2% vs. 2·4%, aRR=1·65, 95% CI 1·14–2·38), be transferred to obstetric care for any reason (17·8% vs 11·9%; aRR=1·41; 95% CI 1·09–1·83), and have any PPH≥ 500 ml (22·7% vs 11·1%, aRR=1·86, 95% CI 1·49–2·32). Among women with a previous PPH, previous blood loss > 1500 ml; uterotonics for previous PPH; Caesarean associated with previous PPH; gestation at admission and higher birthweight were independent risk factors for PPH. ConclusionWomen considering birth in an AMU after a previous PPH should be advised that they are at increased risk of experiencing a subsequent PPH requiring transfer to obstetric care, compared with other multiparous women who have not had a PPH. The absolute risk of a subsequent PPH in this group is low and comparable to the overall risk of having a PPH among women having a spontaneous vaginal birth in England.

A Retrospective Case-Control Study on the Risk Factors of Postpartum Hemorrhage

Aim: To determine the risk factors for postpartum hemorrhage. Study design:A retrospective case-control study Place and duration: This study was conducted at Bolan Medical College and Hospital Quetta from January 2021 to January 2022. Methodology: A total of 115 patients with PPH were identified in the given data.A case was categorized based on blood loss of more than 1500 mL or needing the transfusion of blood due to excessive postpartum blood loss. According to the exclusion criteria, those women who were transfused blood due to anemia were not included in the present study. A total of 225 cases were randomly chosen as controls. Those women did not report having PPH. Results: According to the data collected in our study, a total of 4695 babies were delivered in the given duration of time. Out of those, 115 were identified as cases and 225 were considered as random controls. The frequency of PPH was 2.45%. The commonest etiology of PPH was atony of the uterus (60%) and complications related to the placenta (36%). The risk factors determined to cause PPH was a positive history of PPH, anticoagulant drugs, anemia, severe pre-eclampsia, fibromas in the uterus, multiple pregnancies, and the use of assisted reproduction technologies. Conclusion: Patients having a positive history of PPH are most likely to develop severe PPH. It is the most significant risk factor. The most significant risk factor to cause severe PPH was a positive history of PPH, anticoagulation drugs, severe pre-eclampsia, anemia, multiple pregnancies, and uterine fibromas Keywords: Case-control study, postpartum hemorrhage, Risk factors, High-risk, Obstetric interventions

Trend Changes in the individual contribution of risk factors for postpartum hemorrhage over more than two decades.

Postpartum hemorrhage is an obstetric emergency with a rising incidence. The aim of this study was to identify trends in the specific contribution of various risk factors for postpartum hemorrhage by observing their odds ratios throughout different time periods. In this population-based retrospective cohort study trends of change in odds ratios for known risk factors for postpartum hemorrhage occurring in three consecutive eight-year intervals between 1988 and 2014 were compared. Two multivariable logistic regression models were used in order to identify independent risk factors for postpartum hemorrhage in our population. Trends of various risk factors were compared along the time period of the study. The incidence of postpartum hemorrhage increased from 0.5% to 1988 to 0.6%. Using logistic regression models, preeclampsia, vacuum extraction delivery, retained placenta, perineal or vaginal tears and delivery of a large for gestational age neonate were recognized as independent risk factors for postpartum hemorrhage. While the odds ratios for perineal or vaginal tears significantly increased, odds ratios for delivery of a large for gestational age neonate significantly decreased. Odds ratios for the other risk factors did not change significantly. In our study, not only did the rates of statistically significant risk factors for postpartum hemorrhage change during the study period, the specific contribution of each risk factor changed as well. Having a better understanding of these trends might augment our ability to predict this grave obstetric complication and improve maternal outcomes in the future.

Ultrasound-based nomogram for postpartum hemorrhage prediction in pernicious placenta previa.

Background: Pernicious placenta previa (PPP) is one of the most dangerous complications in pregnancy after cesarean section, with high perinatal mortality. This study aimed to develop a nomogram to predict postpartum hemorrhage in patients with PPP. Methods: A total of 246 patients with confirmed PPP at Shengjing Hospital of China Medical University from January 2018 to December 2021 were included. Patients were divided into to two cohorts depending on a postpartum blood loss of > 1000 ml (n = 146) or ≤ 1000 ml (n = 100). Lasso regression analysis was performed on the risk factors screened by univariate analysis to screen out the final risk factors affecting postpartum hemorrhage. Based on the final risk factors, a Nomogram prediction model with excellent performance was constructed using Logistic regression. A nomogram was constructed with further screening of the selected risk factors of postpartum hemorrhage in PPP. A second nomogram based only on the total ultrasonic risk score was constructed. Decision curve analysis (DCA) was used to evaluate the clinical efficacy of the nomograms. Results: Older age, larger gestational age, larger neonatal birth weight, presence of gestational diabetes mellitus, larger amniotic fluid index, absence of gestational bleeding, and higher ultrasonic risk single score were selected to establish a nomogram for postpartum hemorrhage in PPP. The area under the curve of the nomogram constructed by Lasso regression analysis was higher than that of the ultrasonic total score alone (0.887 vs. 0.833). Additionally, DCA indicated better clinical efficacy in the former nomogram than in the later nomogram. Furthermore, internal verification of the nomogram constructed by Lasso regression analysis showed good agreement between predicted and actual values. Conclusion: A nomogram for postpartum hemorrhage in PPP was developed and validated to assist clinicians in evaluating postpartum hemorrhage. This nomogram was more accurate than using the ultrasonic score alone.

Influence of previous laparoscopic surgical and pathological diagnosis of endometriosis on pregnancy outcomes in women with adenomyosis

ObjectivesPrevious studies demonstrated that endometriosis and adenomyosis are closely linked to lots of adverse pregnancy outcomes while the role of endometriosis in pregnant women with adenomyosis has not been explored yet. The present study aimed to evaluate the influence of previous laparoscopic surgical and pathological diagnosis of endometriosis on pregnancy outcomes in women with adenomyosis. MethodsA total of 60 pregnant women who were diagnosed with adenomyosis before or during pregnancy were included in this study. Among them, 8 were also diagnosed with endometriosis by previous laparoscopic surgery. The demographic characteristics and pregnancy outcomes were compared between women with adenomyosis only and those with the surgical history of endometriosis. ResultsCompared with women with adenomyosis only, those concomitant with the surgical history of endometriosis had significantly higher age at delivery [37.5(36.25–39.75) vs. 35(33.25–37), P ​= ​0.016] and an increased risk of postpartum hemorrhage (PPH) (adjusted OR: 5.992, 95% CI: 1.03–34.857, P ​= ​0.046) while no significant differences were found in other adverse pregnancy outcomes between these two groups. Then we further detected the risk factor of PPH in women with adenomyosis and found that the surgical history of endometriosis (OR: 6.995, 95% CI: 1.16–42.171, P ​= ​0.034) and assisted reproductive technology (ART) (OR: 5.062, 95% CI: 1.494–17.146, P ​= ​0.009) were the parameters closely associated with the occurrence of PPH. ConclusionsThe history of previous laparoscopic surgical and pathological diagnosis of endometriosis in pregnant women with adenomyosis may increase the risk of PPH, which still needs to be verified by future studies with a large sample size. Besides, pregnancy through ART is also an increased risk factor for PPH in women with adenomyosis. Pregnant women with adenomyosis who conceived with the surgical history of endometriosis or by ART should be closely monitored for the reason of being at high risk of PPH.

Analysis of Risk Factors of Postpartum Hemorrhage in Vaginal Delivery Women and Nursing Countermeasures

Analysis of Risk Factors of Postpartum Hemorrhage in Vaginal Delivery Women and Nursing Countermeasures

The MRI estimations of placental thickness and cervical length correlate with postpartum hemorrhage (PPH) in patients with risk for placenta accreta spectrum (PAS) disorders

IntroductionThis study aims to identify whether placental thickness and cervical length measured by MRI correlate with postpartum hemorrhage (PPH) in patients at high risk for placenta accreta spectrum (PAS) disorders. MethodsThe placental thickness and cervical length of 200 patients from October 2017 to October 2021 were retrospectively measured. The mid-sagittal plane of the placentas was measured by 2 independent radiologists using MRI. Partial correlation analysis was used to characterize the correlation between placental thickness, cervical length and estimated blood loss during surgery. The correlation between clinical features, placental thickness, cervical length and PPH was evaluated with univariate and multivariate analyses. A nomogram was constructed based on the logistic regression. ResultsPlacental thickness was positively correlated with the estimated blood loss during delivery, while cervical length had a negative correlation with it, based on the adjustment for gestational age. Multivariate analyses revealed that prior cesarean section, placenta previa, increased placental thickness(≧4.35 cm) and short cervical length（< 3.05 cm） were independent risk factors for PPH. When the 4 risk factors were combined together, the AUC was the highest, 0.773 (95%CI 0.707–0.840). DiscussionPlacental thickness and cervical length correlated with PPH. The nomogram constructed based on prior cesarean section, placenta previa, placental thickness and cervical length can be used to recognize patients with a higher risk of PPH.

Frequency of Postpartum Hemorrhage following Oxytocin use during Labor

Post-partum hemorrhage is one of the major causes of maternal morbidity and mortality worldwide. Efficient and timely management of 3rd stage of labor decreases the loss of blood and reduces the chances of hemorrhage. Prophylactic use of oxytocics plays a key role in the management of 3rd stage of labor. Use of xytocin for augmentation of labor is itself a risk factor for post-partum hemorrhage. This study was designed to find frequency of postpartum hemorrhage following oxytocin use during labor. Objective: To determine frequency of postpartum hemorrhage following oxytocin use during labor. Methodology: It was a Descriptive case control study. Cases were those patients in whom postpartum hemorrhage observed after delivery. Controls were those patients in whom in whom postpartum hemorrhage was not observed after delivery. In both cases and controls, it was observed whether oxytocin was used for augmentation of labor or not. In both groups, frequency of PPH was observed following oxytocin use during labor. Study was conducted in labor ward of Department of Obstetrics &amp; Gynaecology, Sheikh Zayed Hospital, Rahim Yar Khan from 18th June 2018 to 17th December 2018. Results: Mean age of the patients was 27.60±0.19 vs. 27.39±0.20 years respectively in Cases and Controls. Mean gestational age was 38.46±0.05 vs. 38.54±0.06 weeks in Cases and Controls respectively. Oxytocin use was observed in 130(53.28%) vs. 106(43.44%) among Cases and Controls respectively. Conclusion: There is almost 1.5 times increased risk of having post-partum hemorrhage in patients having augmentation with oxytocin during labor. Keywords: Post-partum hemorrhage, augmentation of labor, oxytocics, oxytocin, 3rd stage of labor

PREVENTION AND TREATMENT OF POSTPARTUM HEMORRHAGE: A LITERATURE REVIEW

Background: The main cause of morbidity and maternal mortality is hemorrhage postpartum, with an increasing incidence around the world. Various risk factors for postpartum bleeding are expected to be an effective treatment by health professionals and have a role as advocates, collaborators, educators, service providers, and as researchers must have the latest knowledge in providing optimal and comprehensive care.&#x0D; Objectives: This study aimed to find out the prevention and treatment of hemorrhage postpartum.&#x0D; Design: This study design is a systematic review to search and review articles from database and the descriptive theory.&#x0D; Data Sources: Search scientific articles using the Mendeley application by entering the keywords "Postpartum, Hemorrhage, Prevention, and Treatment" with publication year 2019-2021, English, full text, and open access.&#x0D; Review Methods: The literature review method uses a narrative review to discuss postpartum hemorrhage, its prevention, and treatment. The inclusion criteria are the year of publication 2019-2021, international publications, articles in English, original articles, full text, and open access. Data were collected and a journal summary was made which included the name of the researcher, year of publication of the journal, research title, method, and a summary of the results or findings.&#x0D; Results: From 9 journals that meet the conclusion that active management of the third stage, administration of uterotonics and bimanual compression, is the initial treatment for the prevention and treatment of postpartum hemorrhage.&#x0D; Conclusion: In the prevention of risk factors for postpartum hemorrhage, it is recommended to carry out good active management of the third stage, use of uterotonic drugs according to the recommended dose, early initiation of breastfeeding, and increase the knowledge and skills of health workers.

Postpartum haemorrhage in rural Indigenous women: scoping review of a global obstetrical challenge

ABSTRACT We conducted a scoping review to determine incidence and risk factors for postpartum haemorrhage (PPH) in rural Indigenous women. We systematically searched PubMed (Medline), EMBASE, and CINAHL for all peer-reviewed articles and grey literature regarding Indigenous ethnicity, rural settings, and PPH incidence, risk factors, or maternal outcomes published from inception to 11 January 2021. Eleven articles were deemed relevant after screening and quality assessment using the National Institutes of Health scoring system for mixed study reviews. Of these, 3 articles were good quality, 1 was fair, and 7 were poor. Nine possible risk factors were recorded. The outcomes studied were transfusion, hysterectomy and mortality. PPH research in rural Indigenous women is scarce, mostly low quality and fails to represent most Indigenous cultures and countries. Women from Indigenous groups in rural Canada, Australia and the USA are at higher risk for PPH but specific risk factors are unknown. While widely differing populations made the data difficult to synthesise, this inaugural scoping review highlights a need for further research and increased obstetrical resources in areas where rural Indigenous women reside.

Tranexamic acid administered during cesarean delivery in high-risk patients: maternal pharmacokinetics, pharmacodynamics, and coagulation status

Tranexamic acid is frequently administered for postpartum hemorrhage. The World Health Organization recommends 1 g intravenous dosing, repeated once after 30 minutes for ongoing bleeding. Understanding the pharmacokinetics and pharmacodynamics of tranexamic acid in patients at high risk of postpartum hemorrhage may enable dosage tailoring for optimal antifibrinolysis with minimal adverse events, such as thrombosis or renal cortical necrosis. This study aimed to report tranexamic acid pharmacokinetics and pharmacodynamics after 1 g intravenous dosing during cesarean delivery in patients at risk of hemorrhage. The primary endpoint was tranexamic acid plasma concentration of >10 μg/mL, known to inhibit 80% of fibrinolysis. In addition, the correlation between patient demographics and rotational thromboelastometry coagulation changes were analyzed. In this prospective study, 20 women aged 18 to 50 years, ≥23 weeks of gestation undergoing cesarean delivery with at least 1 major (placenta previa, suspected placenta accreta spectrum, or active bleeding) or 2 minor (≥2 previous cesarean deliveries, previous postpartum hemorrhage, chorioamnionitis, polyhydramnios, macrosomia, obesity, or suspected placental abruption) risk factors for postpartum hemorrhage were recruited. The exclusion criteria were allergy to tranexamic acid, inherited thrombophilia, previous or current thrombosis, seizure history, renal or liver dysfunction, anticoagulation, or category III fetal heart tracing. Tranexamic acid 1 g was administered after umbilical cord clamping. Blood samples were drawn at 3, 7, 15, and 30 minutes and then at 30-minute intervals up to 5 hours. Plasma concentrations were evaluated as mean (standard error). Serial rotational thromboelastometry was performed and correlated with tranexamic acid plasma concentrations. The median age of participants was 37.5 years (interquartile range, 35.0-39.5), and the median body mass index was 28.6 kg/m2 (interquartile range, 24.9-35.0). The median blood loss (estimated or quantitative) was 1500 mL (interquartile range, 898.5-2076.0). Of note, 9 of 20 (45%) received a transfusion of packed red blood cells. The mean peak tranexamic acid plasma concentration at 3 minutes was 59.8±4.7 μg/mL. All patients had a plasma concentration >10 μg/mL for 1 hour after infusion. Plasma concentration was >10 μg/mL in more than half of the patients at 3 hours and fell <10 μg/mL in all patients at 5 hours. There was a moderate negative correlation between body mass index and the plasma concentration area under the curve (r=-0.49; 95% confidence interval,-0.77 to-0.07; P=.026). Rotational thromboelastometry EXTEM maximum clot firmness had a weak positive correlation with longitudinal plasma concentration (r=0.32; 95% confidence interval, 0.21-0.46; P<.001). EXTEM maximum clot lysis was 0% after infusion in 18 patients (90%), and no patient in the study demonstrated a maximum lysis of >15% at any interval from 3 minutes to 5 hours. There was no significant correlation between EXTEM clot lysis at 30 minutes and longitudinal tranexamic acid plasma concentrations (r=0.10; 95% confidence interval,-0.20 to 0.19; P=.252). After standard 1 g intravenous dosing of tranexamic acid during cesarean delivery in patients at high risk of hemorrhage, a plasma concentration of ≥10 μg/mL was sustained for at least 60 minutes. Plasma tranexamic acid levels correlated inversely with body mass index. The concurrent use of rotational thromboelastometry may demonstrate tranexamic acid's impact on clot firmness but not a hyperfibrinolysis-derived trigger for therapy.

Determining the incidence of postpartum haemorrhage among Ontario women with and without inherited bleeding disorders: A population-based cohort study.

At a population level, there is a poor understanding of the incidence and pre-disposing risk factors of postpartum haemorrhage (PPH) among women with inherited bleeding disorders (IBD). To determine the incidence of PPH, and identify maternal factors associated with risk of PPH among women with IBD. We conducted a retrospective cohort study using data housed within ICES (formerly known as the Institute for Clinical Evaluative Sciences). The cohort included women with an in-hospital, live or stillborn delivery, between January 2014 and December 2019. The primary outcome was PPH (identified by ICD-10 code O72). PPH incidence and risk factors were compared between women with and without IBD. Temporal trends were assessed using the Cochrane-Armitage test. Between group differences were assessed using standardised differences (std. difference). Total 601,773 women were included; 2002 (.33%) had an IBD diagnosis. PPH incidence was 1.5 times higher (7.3 vs. 4.9 cases/100 deliveries, std. difference .1) among women with IBD compared to women without. Women with IBD were slightly older (31.7 vs. 30.7 years), had higher rates of hypertension, previous PPH, and induction of labour. Women with IBD were more frequently diagnosed with anaemia (4.8% vs. 1.8%; std difference .17) and had lower haemoglobin levels at admission for delivery compared to women without IBD. This study contributes to the literature regarding obstetric bleeding among women with IBD, showing that anaemia at delivery may be an important risk factor for PPH. Given their predisposition to anaemia, clarifying this relationship will optimise management and outcomes.

Twin Growth Discordance and Risk of Postpartum Hemorrhage: A Retrospective Cohort Study.

BackgroundIn recent years, the incidence of postpartum hemorrhage has increased globally. Multiple pregnancies and cesarean sections are well-known risk factors for postpartum hemorrhage. No studies have evaluated the associations between fetal growth anomalies and postpartum hemorrhage in women with twin pregnancies undergoing cesarean section. This study aimed to identify the relationship between fetal growth anomalies and postpartum hemorrhage in women with twin pregnancies undergoing cesarean section.MethodsThis retrospective single-center study included 3,180 women with twin pregnancies at a tertiary hospital between August 2013 and July 2020. Singleton reference charts were used to assess fetal growth restriction at birth. Discordant growth was defined as an intertwin birth weight difference of ≥20%. Logistic regression analyses were used to evaluate the association between fetal growth anomalies and postpartum hemorrhage. Additionally, sensitivity analysis of abnormal placenta and stratification by twin chorionicity were conducted.ResultsThe overall incidence of postpartum hemorrhage was 4.3%. Twin growth discordance, especially with fetal growth restriction, was associated with an increased risk of postpartum hemorrhage (adjusted odds ratio [AOR] = 1.62, 95% confidence interval [CI], 1.05–2.51, P = 0.031; AOR = 1.71; 95% CI, 1.08–2.70, P = 0.022; AOR = 1.98, 95% CI, 1.21–3.25, P = 0.006, respectively). After stratification, this relationship persisted in dichorionic twins (OR = 1.71, 95% CI, 1.04–2.82, P = 0.036; OR = 1.90, 95% CI, 1.13–3.21, P = 0.016; OR = 2.48, 95% CI, 1.41–4.38, P = 0.002, respectively). However, no significant association was observed in monochorionic twin pregnancies.ConclusionGrowth discordance, especially complicated by fetal growth restriction, was associated with an increased risk of postpartum hemorrhage in women with twin pregnancies undergoing cesarean section, and was more evident in patients with dichorionic twins.

Incidence of postpartum hemorrhage and risk factors for recurrence in the subsequent pregnancy.

To assess incidence and risk factors for postpartum hemorrhage (PPH) and identify women at high risk of recurrence in the subsequent pregnancy. 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 1000mL or more within 24h 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. 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). 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.