Risk Of Postpartum Hemorrhage Research Articles

Intrauterine pressure catheter use and risk of placental abruption and postpartum hemorrhage

Intrauterine pressure catheter use and risk of placental abruption and postpartum hemorrhage

Effects of Short Interpregnancy Intervals on Adverse Pregnancy Outcomes - Haidian District, Beijing Municipality, China, 2017-2019.

Interpregnancy intervals (IPIs) that are either excessively long or short have been linked with an elevated risk of adverse perinatal outcomes. Presently, no pertinent guidelines have been established in China to provide clear direction with regard to optimal IPI. A brief interpregnancy interval may elevate the risk of miscarriage, postpartum hemorrhage, and fetal distress among expectant women. These results could inform prenatal consultations, guiding pregnant women towards an ideal interpregnancy interval of no less than 24 months.

Increased peripartum bleeding complications in very advanced maternal age patients who conceive via in-vitro fertilization

Peripartum bleeding is a cause of severe maternal morbidity (SMM). In-vitro fertilization (IVF) is associated with hemorrhage risk factors, but is included in risk stratification. Very advanced maternal age patients (≥45 years at delivery) are more likely to require IVF. Our aim was to determine if vAMA patients who conceive with IVF are at increased risk of postpartum hemorrhage, blood transfusion, or unplanned hysterectomy compared to patients with non-IVF pregnancies.

Retrospective analysis of maternal near miss and the applicability of previous caesarean section delivery as a predictor of risk at a tertiary level hospital of India

Background: Caesarean section (CS) rate is showing an alarming increase in India, as a result, high-risk pregnancies with previous CS are becoming more frequent. Objective: The present study compared the additional risk for previous CS among a retrospective cohort of women who had maternal near miss (MNM). Materials and Methods: Record analysis of women with MNM between April 2019 and March 2020 at the tertiary level teaching hospital of Kolkata, India. Data for the selected study variables were extracted from the patient's case record forms. The main outcome measures were crude odd's ratio for risk of post-partum haemorrhage (PPH), repeat CS and adverse birth outcome; difference of mean for units of blood products transfused, number of clinical signs and hospital stay and adjusted odds ratio for PPH. Results: In this study, 100 records were analysed. The mean age of the cohort was 27.65 years with a standard deviation (SD) of 6.25 years. Forty women had previous CS, among whom 27 (67.5%) had a single CS while 13 (32.5%) had CS twice. A number of clinical signs, duration of hospital stay, total units of packed red cells (PRBCs) and total units of blood products transfused were similar between the groups. Women with previous CS had a significantly higher risk for PPH and having a repeat CS in the present pregnancy. CS at the present pregnancy was the only predictor for PPH after adjusting for other variables. Conclusion: It is difficult to ascertain whether a patient's antepartum and intrapartum course prior to delivery is responsible for the patient's morbidity, or if the previous CS is responsible for some component of the adverse outcomes. Repeated, poor-quality, repeated, closely-spaced CS, can likely result in maternal morbidity, especially PPH. The effect of CS not only affects the incident pregnancy, but future ones as well.

Does chronic Low Molecular Weight Heparins use during pregnancy increase the risk of postpartum hemorrhage?

Does chronic Low Molecular Weight Heparins use during pregnancy increase the risk of postpartum hemorrhage?

POSTPARTUM HEMORRHAGE

Postpartum haemorrhage (PPH) is the primary cause of maternal mortality and morbidity worldwide: in fact, about a quarter of deaths that occur during pregnancy, childbirth or the puerperium are caused by postpartum hemorrhage. There are many causes of postpartum haemorrhage, the most important are: uterine atony, lacerations of the cervix and/or perineum, retention of placental material, coagulation problems, uterine inversion, uterine rupture. This causes of PPH are represented by the '4Ts' formula: tone, tissue, trauma, thrombin. An important role is played by prevention: identification of risk factors, prophylaxis with oxytocin at the time of delivery, early treatment. The first important thing is the quantification of blood loss because the clinical signs are often blurred and due to frank anaemia resulting in tachycardia, small and frequent pulse, hypotension, sweating, paleness. As previously mentioned, it is important to act early in the case of PPH through maintenance of volaemia and targeted therapies that differ according to the cause of PPH (the 4T algorithm is useful). Early intervention reduces the need for blood transfusions and reduces the incidence of serious complications such as DIC. However, the management of postpartum haemorrhage is not limited to the postpartum phase, but the patient must be monitored in the puerperium, a phase in which the thromboembolic risk is increased. The couple must also be informed of the risk of PPH in future pregnancies. PPH represents a serious risk for the patient and requires multidisciplinary input and proper preparation of the team working in the delivery room.

Blood salvage at the time of vaginal delivery in patients at high risk for hemorrhage

Maternal hemorrhage is the leading cause of maternal morbidity worldwide (1). Autologous transfusion of filtered blood collected at the time of vaginal postpartum hemorrhage (PPH) is safe and eliminates the risk of donor blood transfusion (2). This pilot study assesses the feasibility and potential benefit of salvaging blood at the time of vaginal delivery in patients at high risk for PPH. 30 subjects were recruited. Patients with history of PPH, grand multiparity, multiple gestation, Large for Gestational Age fetus, polyhydramnios, prolonged labor ( >18 hours of Pitocin), or known fibroid uterus were approached. Waiver of consent was obtained from the IRB. HEMAsavR (TM) suction canister was used to collect blood loss. Gem 5000 blood gas analyzer was used to determine the hematocrit (Hct) of the blood collected. Using the Hct and the total volume in the canister, we calculated the estimated percentage of a unit of blood that could be auto transfused. All patients were multiparous, with a median parity of 5. Mean age was 34 (25-42). Mean gestational age was 39w3d. Mean quantitative blood loss (QBL) was 199cc (25 - 550). There were no cases of peripartum hemorrhage. QBL could not be calculated in four cases. Reasons included suction malfunction, arrest of dilation resulting in cesarean, precipitous delivery and insufficient blood loss. The sample Hct could not be calculated in an additional five cases due to insufficient blood loss. Mean Hct of a cell salvage unit (pRBC) is ∼55% (3) and the volume of a pRBC unit is 250cc. Use of HEMAsavR resulted in salvage of 39% (4-90) of a unit that would be available for autologous transfusion. In our high risk cohort of pregnant persons, the use of the Hemasavr device allowed for salvage of > 1/3 of a unit of pRBC. Future use of autologous transfusion of vaginal blood may provide a safe and effective way to manage peripartum hemorrhage.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Postpartum hemorrhage risk assessment—revisiting the three-tiered classification of low- medium- and high-risk

ACOG promulgates classification of individuals admitted for delivery into three-tiers for postpartum hemorrhage (PPH): Low-, Medium-, or High-Risk. We sought to report the frequency of each tier and the clinical outcomes linked to each one. Over 12 consecutive months, charts of all singletons who delivered at a Level IV maternal center were reviewed. Multiple gestations and those transferred after delivery were excluded. Using pre-defined criteria, chart abstraction was done by qualified medical personnel, and data quality was audited on 10% of the charts by staff not involved in data abstraction. Using the California Maternal Quality Care Collaborative (CMQCC) schema, with the known risk factors until delivery, all singletons were categorized into three tiers. PPH was defined as estimated or quantitative blood loss ≥1,000 mL. We contrasted risks of composite maternal morbidity (CMM) among all classification groups, with a relative risk (RR) with a 95% confidence interval (CI) as the effect measure calculated using Poisson regression adjusted for potential confounders. Of the 4,516 singletons, 1,854 (41%) were categorized as being low-risk, 1,239 (27%) were medium-, and 1423 (32%) as high-risk. The risk factors for the 3 groups are in Table 1. The risk of CMM was 19% higher in the medium versus low-risk groups (RR 1.19, 95% CI 1.03-1.36) and 16% higher comparing high versus low-risk groups (RR 1.16, 95% CI 1.02-1.32), but not amongst the medium vs. high-risk groups (aRR 0.98, 95% CI 0.85-1.12). Blood loss of at least 1,000 mL and transfusion followed a similar pattern to the CMM (Table 2). The three maternal deaths were not directly related to PPH. At our Level IV maternal center, the three-tiered postpartum hemorrhage classification performed poorly since over 1 out 5 “low-risk” had hemorrhagic sequelae and no difference in outcomes was noted between medium versus high-risk groups. A better predictive model is needed for PPH and associated morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Assessment of the clinical outcomes of diabetes exposure during pregnancy on mothers and their neonates. A cohort study

Background. Gestational diabetes is a metabolic disorder that occurs in more than 8% of all pregnancies. Hence, this study aims to investigate the relationship between gestational diabetes and the clinical outcomes of mothers and their infants in Ilam city. Methods. This study was conducted as a retrospective cohort. All diabetic pregnant mothers referring to obstetrics, gynecology clinics, and comprehensive health service centers were randomly selected. The clinical outcomes were analyzed using SPSS20. Results. In total, 332 pregnant women, including 166 diabetics and 166 non-diabetics with a mean age of 32.3 years, participated. Of the diabetic mothers, 31 people had overt diabetes before pregnancy. The results of this study revealed that the relative risk of neonatal jaundice in diabetic mothers was about seven times higher than that of non-diabetic mothers (P=0.001, RR=7). The relative risk of postpartum hemorrhage was about six times (P=0.001, RR=5.9), blood hypertension was two times (P=0.013, RR=2.4) and the need for cesarean delivery was two times (P=0.009, RR=2.6), preeclampsia was 1.4 times (P= 0.011, RR=1.4) neonatal infection was twice (P=0.002, RR=2.1), respiratory distress was one-third (P=0.012, RR=1.3), compared to non-diabetic mothers. Furthermore, diabetes and other clinical outcomes studied in mothers and infants were not significant. Conclusion. The results showed that pregnant mothers with diabetes are more likely to suffer from postpartum hemorrhage and blood pressure as well as toxemia during pregnancy. In addition, their neonates have a higher risk of neonatal icterus. Health care providers and pregnant mothers should consider these risks in prenatal care. Practical Implications. Since diabetes is a dangerous complication during pregnancy and can have detrimental effects on the mother and fetus, therefore, it is crucial to study the factors affecting its occurrence so that by recognizing the risk factors and consequences, an effective step can be taken to control this disorder.

Development and Validation of a Predictive Tool for Postpartum Hemorrhage after Vaginal Delivery: A Prospective Cohort Study.

Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity worldwide. This study aimed to develop and validate a predictive model for PPH after vaginal deliveries, based on routinely available clinical and biological data. The derivation monocentric cohort included pregnant women with vaginal delivery at Brest University Hospital (France) between April 2013 and May 2015. Immediate PPH was defined as a blood loss of ≥500 mL in the first 24 h after delivery and measured with a graduated collector bag. A logistic model, using a combination of multiple imputation and variable selection with bootstrap, was used to construct a predictive model and a score for PPH. An external validation was performed on a prospective cohort of women who delivered between 2015 and 2019 at Brest University Hospital. Among 2742 deliveries, PPH occurred in 141 (5.1%) women. Eight factors were independently associated with PPH: pre-eclampsia (aOR 6.25, 95% CI 2.35-16.65), antepartum bleeding (aOR 2.36, 95% CI 1.43-3.91), multiple pregnancy (aOR 3.24, 95% CI 1.52-6.92), labor duration ≥ 8 h (aOR 1.81, 95% CI 1.20-2.73), macrosomia (aOR 2.33, 95% CI 1.36-4.00), episiotomy (aOR 2.02, 95% CI 1.40-2.93), platelet count < 150 Giga/L (aOR 2.59, 95% CI 1.47-4.55) and aPTT ratio ≥ 1.1 (aOR 2.01, 95% CI 1.25-3.23). The derived predictive score, ranging from 0 to 10 (woman at risk if score ≥ 1), demonstrated a good discriminant power (AUROC 0.69; 95% CI 0.65-0.74) and calibration. The external validation cohort was composed of 3061 vaginal deliveries. The predictive score on this independent cohort showed an acceptable ability to discriminate (AUROC 0.66; 95% CI 0.62-0.70). We derived and validated a robust predictive model identifying women at risk for PPH using in-depth statistical methodology. This score has the potential to improve the care of pregnant women and to take preventive actions on them.

The Impact of Overweight and Obesity in Early Pregnancy on Maternal and Fetal Outcome

The recent increase in prevalence of overweight and obesity in pregnancy has become a major public health problem as it is associated with increased risk of obstetric and neonatal complications. A hospital based observational comparative study was done on women attending obstetrics and gynecology outpatient department of a tertiary care hospital in Kathmandu from September 2021 to January 2022 after taking ethical clearance from Institutional Review Committee. A total of 113 overweight/obese women in first trimester of singleton pregnancies and similar number of women with normal BMI were recruited for the study and followed throughout pregnancy for the development of maternal complications like gestational hypertension, gestational diabetes mellites, antepartum hemorrhage, preterm labor and postpartum hemorrhage. The neonatal outcome compared were birth weight, low Apgar score at birth and NICU admission. Maternal overweight/obesity as compared to normal BMI was associated with increased risk of gestational diabetes mellites (RR 2.06, 95% CI: 1.2 to 3.52; P value = 0.006), gestational hypertension (RR 2.2, 95% CI: 1.09 to 4.43; P value = 0.02) and caesarean delivery (RR 1.81, 95% CI: 1.28 to 2.55; P value = 0.004). The risk of primary postpartum hemorrhage was also increased in overweight/ obese women than in normal weight women (RR 2.8, 95% CI: 1.04 to 7.51; P value=0.03). In neonatal outcomes, the mean birth weight (3.18 + 0.54 kg vs 2.9 + 0.33kg, P value < 0.001) and admission to NICU (28.3% vs 10.61%, P value = 0.008) were significantly higher in overweight/ obese women. Maternal overweight/obesity in early pregnancy is associated with higher risk of adverse pregnancy and neonatal outcome.

High prevalence of postpartum hemorrhage in women with rare bleeding disorders in the Netherlands: retrospective data from the RBiN study

BackgroundWomen with rare bleeding disorders (RBDs), including coagulation factor deficiencies and fibrinolytic disorders, may have a higher risk of postpartum hemorrhage (PPH). Information on this patient category is lacking in the existing PPH guidelines because data on PPH in patients with RBDs are scarce. ObjectiveTo describe the prevalence of PPH in women with an RBD and evaluate the use of peripartum hemostatic prophylaxis. MethodsIn the Rare Bleeding Disorders in the Netherlands (RBiN) study, patients with RBDs (n = 263) were included from all 6 Dutch hemophilia treatment centers. Patient–reported information on delivery, peripartum hemostatic prophylaxis, and occurrence of PPH was collected retrospectively. If available, information about the precise volume of postpartum blood loss was extracted from electronic patient files. PPH was defined as blood loss ≥500 mL (World Health Organization guideline). ResultsA total of 244 pregnancies, including 193 livebirths, were reported by 85 women. A considerable proportion of these women experienced PPH, ranging from 30% in factor V deficiency to 100% in hyperfibrinolysis. Overall, PPH was reported in 44% of deliveries performed with and 53% of deliveries performed without administration of peripartum hemostatic prophylaxis. Blood loss was significantly higher in deliveries without administration of hemostatic prophylaxis (median 1000 mL) compared to deliveries with administration of prophylaxis (median 400 mL) (p = 0.011). Patients with relatively mild deficiencies also frequently experienced PPH when peripartum hemostatic prophylaxis was omitted. ConclusionPPH is common in rare coagulation factor deficiencies, both severe and mild, and fibrinolytic disorders, especially when peripartum prophylactic hemostatic treatment was not administered. The use of prophylactic hemostatic treatment was associated with less postpartum blood loss.

1963. Peripartum Outcomes Associated With COVID-19 Vaccination during Pregnancy: A Systematic Review and Meta-analysis

Abstract Background The risk and benefits of coronavirus disease 2019 (COVID-19) vaccination during pregnancy are under investigation. Pooled evidence regarding neonatal and maternal outcomes in relation to COVID-19 vaccination during pregnancy is scarce. Methods We searched PubMed and EMBASE databases in April 2022 without language restrictions. We included Prospective trials and observational studies comparing the women who received at least one COVID-19 vaccination during pregnancy with those who did not and reporting neonatal outcomes. Two independent investigators extracted relevant data from each study. Odds ratios (ORs) were calculated using random-effects models. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The primary outcomes were the neonatal outcomes, including preterm birth, small-for-gestational-age (SGA), low Apgar score (< 7 at 5 min), neonatal intensive care units (NICU) admission, and intrauterine fetal death (IFD). The secondary outcomes were maternal outcomes, including maternal SARS-CoV-2 infection, cesarean delivery, postpartum hemorrhage, and chorioamnionitis. Results Nine observational studies involving 81,349 vaccinated (mean age, 32.0±4.6 years) and 255,346 unvaccinated women during pregnancy (mean age, 30.5±5.1 years) were included. COVID-19 vaccination during pregnancy was associated with lower risk of NICU admission (OR, 0.88; 95% confidence intervals [CI], 0.80-0.97) and IFD (OR, 0.73; 95% CI, 0.57-0.94), whereas it was not associated with preterm birth (OR, 0.89; 95% CI, 0.76-1.04), SGA (OR, 0.99; 95% CI, 0.94-1.04), and low Apgar score (OR, 0.94; 95% CI, 0.87-1.02). COVID-19 vaccination during pregnancy was associated with a lower risk of maternal SARS-CoV-2 infection (OR, 0.46; 95% CI, 0.22-0.93), but not associated with increased risk of cesarean delivery (OR, 1.05; 95% CI, 0.93-1.20), postpartum hemorrhage (OR, 0.95; 95% CI, 0.83-1.07), and chorioamnionitis (OR, 0.95; 95% CI, 0.83-1.07). Flowchart of study selection Forest plots showing the odds ratio of neonatal outcomes a: neonatal intensive care units admission, b: intrauterine fetal death, c: preterm birth, d: small for gestational age, e: low Apgar score Forest plots showing the odds ratio of maternal outcomes a: maternal SARS-CoV-2 infection, b: cesarean delivery, c: postpartum hemorrhage, d: chorioamnionitis Conclusion COVID-19 vaccination during pregnancy did not increase the risk of peripartum outcomes but decreased the risk of NICU admission, IFD, and maternal COVID-19 infection. COVID-19 vaccination should be encouraged for pregnant women. Disclosures All Authors: No reported disclosures.

The Effect of Anemia in Pregnancy on Postpartum Hemorrhage

Eighty percent of maternal deaths are caused by complications during pregnancy and childbirth. Furthermore, twenty-five percent of maternal deaths is affected by postpartum hemorrhage which is estimated 100,000 deaths annually. Indonesia places at the second ranks of the highest maternal deaths country after Laos. The cause of death in Indonesia is 28% by hemorrhage. The hemorrhage in maternity is due to anemia in pregnancy. It occurs because when the mother gives birth, there will be adequate uterine contractions so that the hemorrhage is inevitable. The objective of the study is to identify the effect of anemia in pregnancy on the incidence of postpartum hemorrhage. The type of research employed is an analytic survey with a retrospective design. The research location was at Juata Tarakan Health Center. The population in this study were all pregnant women who visited the obstetrics and gynecology polyclinic in 2020 which was obtained from secondary data, the patient's medical record book at the Juata Public Health Center with a sample of 271 on June 23 to August 31, 2021. Sampling employed a non-probability sampling technique, total sampling, and the data analysis was administered univariately, and bivariate with chi-square test. The incidence of postpartum hemorrhage in women giving birth in the working area of the Juata Tarakan Health Center is 12.9%. Anemia in pregnancy possesses a significant effect on the risk of postpartum hemorrhage with p value (OR=11,253, 95%CI 5,120-24,732). Meanwhile, parity, age, type of delivery did not possess significant effect on postpartum hemorrhage. Mothers with anemia in pregnancy own a higher risk of postpartum hemorrhage which was 11.253 times greater than mothers who were not anemic in pregnancy. Therefore, it is necessary to perform proper handling of anemia in pregnant women to prevent postpartum hemorrhage.

Fetal Biometry and Doppler Assessment of Pregnant Women with COVID-19

Background: The world has changed radically because of the worldwide COVID-19 pandemic. SARS-CoV-2, a unique strain of large, enveloped single-stranded RNA viruses, that has spread around the world. The primary objective of this research was to assess the fetal growth velocity in pregnancies complicated by SARS-CoV-2 infection and those that were not. The secondary objective was to determine if SARS-CoV-2 infection may affect maternal and fetal Doppler readings. Methods and Results: A total of 250 pregnant women diagnosed with SARS-CoV-2 (Case group) were compared to 300 healthy pregnant women (Control group) in a prospective case-control study in Mosul from February 20 to October 20, 2021. Infections during pregnancy were detected and verified using the real-time reverse transcriptase-polymerase chain reaction (RT-PCR). All ultrasound exams were done from 24 to 40 weeks. Measuring parameters using Doppler ultrasonography included plasticity and resistive indices (PI, RI), as well as cerebroplacental ratio computed according to gestational age. Fetal development in utero was assessed by measuring biometric markers, such as parietal diameter, head size, belly circumference, leg length, and estimated fetal weight every four weeks. The US scans in the second and third trimester of pregnancy showed no evidence of congenital abnormalities (P=0.7047). There was a significant incidence of cesarean delivery (P=0.0000) and lower fetal activity at birth (P=0.0000) in the Case group, compared to the Control group. Anticoagulant treatment during pregnancy was not associated with an increased risk of postpartum hemorrhage in women of the Case group. Also, there were no significant differences in fetal biparietal diameter and femur length between groups in the second and third trimesters, and both fetal and maternal Doppler studies throughout the second and third (35-37 weeks) trimesters of pregnancy yielded no significant differences in the PI and RI indices.

Reproductive health and hemostatic issues in women and girls with congenital factor VII deficiency: A systematic review

BackgroundCongenital factor VII (FVII) deficiency is an inherited bleeding disorder, with heterogenous bleeding symptoms. Women with FVII deficiency face hemostatic challenges during menstruation, ovulation, and childbirth. This systematic review evaluated prevalence and management of bleeding symptoms associated with gynecological and obstetric issues in women with FVII deficiency. MethodsDatabases (BIOSIS Previews, Current Contents Search, Embase, and MEDLINE) were searched for studies reporting FVII deficiency and gynecological or obstetric issues in women. Articles were screened using Joanna Briggs Institute checklists and relevant data extracted. ResultsOne hundred fourteen women were identified from 62 publications. Forty‐six women had severe deficiency (FVII:C < 5% or <5 IU/dl). Heavy menstrual bleeding (HMB) was the most common bleeding symptom (n = 94; 82%); hospitalization and urgent medical/surgical interventions for acute HMB episodes were required in 16 women (14%). Seven women reported ovarian bleeding (6%); other bleeding symptoms varied. Patient management was inconsistent and included hemostatic and hormonal treatments. Only four women (7%) reporting vaginal bleeding during pregnancy. Postpartum hemorrhage (PPH) occurred following 12/45 deliveries (27%; 5 [42%] requiring blood transfusion) and was not necessarily prevented by prophylaxis (8 women). ConclusionWomen with congenital FVII deficiency have an increased risk of HMB, ovarian bleeding, and PPH, impacting quality of life. Recognition of a bleeding disorder as the cause is often delayed. Management of bleeding complications is heterogeneous due to lack of treatment guidelines. Harmonizing severity classification of FVII deficiency may help standardize treatment strategies and development of specific guidelines for these women.

Role of variation in platelet indices in pregnancy-related pathological complications and the prediction of postpartum hemorrhage: a case-control study

Pregnancy-related pathological complications (PPCs) increase the risk of postpartum hemorrhage (PPH), Platelet activation and destruction are expected outcomes of PPCs. This study sought to compare the platelet indices of non-pregnant (NP) child-bearing aged women, healthy pregnant (HP) women, and women with PPCs, and investigate the use of these indices in PPH prediction. This retrospective clinical study included 260 NP child-bearing aged women and 119 pregnant women. Of the 119 pregnant patients, 69 had HPs and 50 suffered from PPCs. Further, 50 patients delivered with PPH. We compared the platelet counts (PCs), mean platelet volumes (MPVs), platelet distribution widths (PDWs), plateletcrits (Pcts), MPV ratios (PC/MPV and Pct/MPV), alpha angles (angles), and maximum amplitudes (MAs) of the patients using Sysmex XN10 hematology analyzer and TEG 5000 Hemostasis analyzer system, respectively. With the exception of PDW, there were significant differences in the platelet parameters of the NP, HP, and PPC patients (P<0.05). The intergroup comparison results showed that the NP patients differed significantly from the HP and PPC patients in terms of age, MA, PC, Pct, and Pct/MPV (P<0.0125). Further, the HP and PPC patients differed significantly in terms of Pct, MPV, PC/MPV, and Pct/MPV (P<0.0125). Additionally, the univariate analysis showed that in the PPC patients, low MPV values were strongly related to PPH [odds ratio (OR) =0.012, P=0.003; OR =0.331, P=0.047]. Women with PPCs had significantly lower PC, Pct, PC/MPV and Pct/MPV values, but significantly higher MA and MPV values. PPHs were strongly related to PPC and low MPV values. A timely accurate diagnosis and evaluating MPV values may be useful in the prediction of PPH.

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.

Preventing Postpartum Hemorrhage After Cesarean Delivery: A Network Meta-Analysis of Available Pharmacologic Agents

(Am J Obstet Gynecol. 2022;226:347–365) Postpartum hemorrhage (PPH) is a leading cause of maternity mortality. Cesarean deliveries (CDs) put women at an increased risk of PPH. The World Health Organization (WHO) suggests oxytocin be administered to women to mitigate the risk of PPH without regards to type of delivery or whether CD was prepartum or intrapartum. This study aimed to use network meta-analysis (NMA) to determine whether prophylactic agent efficacy is influenced by surgical context for parturients undergoing CD.