Prevalence and Risk Factors of Severe Postpartum Hemorrhage: a Retrospective Cohort Study

Abstract Background: Although maternal deaths are rare in developed regions, the morbidity associated with severe postpartum hemorrhage remains a major problem. To provide new insight into severe postpartum hemorrhage, we analyzed data of women giving birth in Guangzhou Medical Centre for Critical Pregnant Women, which receiveda large quantity of critically ill obstetric patients from other hospitals of Southern China. Methods: In this study, we conducted a retrospective cohort by using the criteria of severe maternal morbidities, which was defined by estimation of blood loss volume and use of blood transfusion≥4 units, to determine the prevalence, risk factors and short-term complications of severe postpartum hemorrhage. Results: Severe postpartum hemorrhage was observed in 532 mothers (1.56%) among the total population of 34 178 mothers. Placental related cause (55.83%) was the major identified cause of severe postpartum hemorrhage, while uterine atony without associated retention of placental tissues accounted for 38.91%. The risk factors for severe postpartum hemorrhage were maternal age<18 years, previous cesarean section, history of postpartum hemorrhage, conception through in vitro fertilization, pre-delivery anemia, stillbirth, prolonged labor, placenta previa, placental abruption, placenta accrete spectrum and macrosomia. The prevalence rates of admission to ICU, hysterectomy, acute renal failure and sepsis were significantly higher in women with severe postpartum hemorrhage. Conclusion:The results of this study suggested that severe postpartum hemorrhagecould be adopted as an indicator to assess the quality of obstetric care because of its severity and potential lethality. Extra vigilance during the antenatal and peripartum periods is needed to identify women who have risk factors and enable early intervention to prevent severe postpartum hemorrhage. It’s important to remember that we have to prepare for all mothers giving birth, as some get severe postpartum hemorrhagewithout any known risk factors.

Download Full-text

THE EFFECT OF MODIFIABLE RISK FACTORS ON IMPLANTATION SUCCESS FOLLOWING IN-VITRO FERTILIZATION: A RETROSPECTIVE COHORT

Fertility and Sterility ◽

10.1016/j.fertnstert.2020.08.898 ◽

2020 ◽

Vol 114 (3) ◽

pp. e332

Author(s):

Emily E. Lenk ◽

James W. Akin

Keyword(s):

Risk Factors ◽

In Vitro Fertilization ◽

Retrospective Cohort ◽

Modifiable Risk Factors ◽

Vitro Fertilization ◽

Implantation Success

Download Full-text

Effects of Placenta Location in Pregnancy Outcomes of Placenta Accreta Spectrum (PAS); A Retrospective Cohort Study

Journal of Family & Reproductive Health ◽

10.18502/jfrh.v15i4.7888 ◽

2021 ◽

Author(s):

Shokoh Abotorabi ◽

Solmaz Chamanara ◽

Sonia Oveisi ◽

Maryam Rafiei ◽

Leila Amini

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Placenta Accreta ◽

Placenta Previa ◽

Chi Square ◽

Gestational Age At Delivery ◽

History Of ◽

Placenta Accreta Spectrum

Objective: Placenta Accreta Spectrum (PAS) affects approximately one in a thousand deliveries. Very few studies evaluated PAS risk factors based on their location. In this study, we have investigated the effects of placenta location on placental adhesion-related complications, its risk factors, and outcomes. Materials and methods: We performed a retrospective cohort study of pathology-confirmed cases of PAS from patients with peripartum hysterectomy, at a large educational hospital in Qazvin, Iran, from 2009 to 2019. Placenta location was found by ultrasound reports and intraoperative evaluation. We measured demographic features, basic characteristics, maternal and neonatal outcomes based on placental location including anterior, posterior, and lateral in Placenta Accreta Spectrum. Chi-square, t-test, and one-way ANOVA were used to examine the relation of complications, risk factors, and outcomes in PAS. Results: A review of 70 cases showed the distribution of placenta location as follows: 57% anterior, 27% posterior, and 16% lateral. The mean gestational age at delivery was 35 (33-39) weeks. In 78.6% (n=55) of the patients, an association with placenta previa and in 94/2% (n=66) of cases a history of cesarean section was found, however, it was not significantly correlated with placenta location (p=0.082). We found that surgery duration was significantly longer in patients with lateral PAS (155±38, vs 129.35±33.8 and 133.15±31.5 for anterior and posterior placenta respectively, p=0.09). Patients with lateral PAS also bled more than the remaining two groups (2836 ml for lateral PAS vs 2002 and 1847 for anterior and posterior placenta respectively, p=0.022). Moreover, women with a history of uterine surgery were more likely to have posterior PAS compared to those with anterior and lateral PAS (p=0.035). Conclusion: Differences in complications, risk factors, and outcomes of PAS based on placenta location may lead to improved diagnosis and decreased morbidity in women.

Download Full-text

Endometrial Osseus Metaplasia during Infertility Evaluation: A Case Series

Annual Research & Review in Biology ◽

10.9734/arrb/2021/v36i930428 ◽

2021 ◽

pp. 86-93

Author(s):

J. O. Imaralu ◽

A. A. Akadri ◽

T. O. Solaja ◽

O. I. Odelola ◽

C. C. Nwankpa

Keyword(s):

Risk Factors ◽

Case Series ◽

Rare Condition ◽

Complete Removal ◽

Trimester Abortion ◽

Vitro Fertilization ◽

Infertile Women ◽

History Of ◽

Second Trimester Abortion

Aims: To highlight the pathogenesis of endometrial osseus metaplasia, its importance as a rare cause of infertility and the benefit of hysteroscopic evaluation of infertile women with risk factors for osseus metaplasia. Presentation of Case: A diagnosis of endometrial osseus metaplasia was confirmed histologically in three women undergoing diagnostic hysteroscopy as part of infertility evaluation. They all had chronic vaginal discharge and a preceding history of induced second trimester abortion. Two of the patients were referred for evaluation before in-vitro-fertilization (IVF). Hysteroscopy was done with a 30° telescope, initially using a 2-channel diagnostic sheath, which was later replaced with a 4-channel operating sheath for tissue retrieval. Discussion: Endometrial osseus metaplasia is a rare condition characterized by the presence of mature or immature bone in the endometrial cavity. Endometrial retention of embryonic tissue following an abortion is the commonest theory of etio-pathogenesis. It is an important cause of infertility and while other causes of infertility can be easily by-passed in an IVF cycle, endometrial factors may not be addressed by IVF alone, as a defective endometrium is a risk for failure. Although there is no consensus on routine hysteroscopy for women undergoing IVF, it is the mainstay of evaluation and treatment of women with endometrial osseus metaplasia. Conclusion: Only complete removal of metaplastic tissue would restore fertility, in patients with osseus metaplasia. Hysteroscopy done in infertile women with risk factors for endometrial osseus metaplasia may enhance early treatment and ultimately increase successful spontaneous and IVF pregnancy rates.

Download Full-text

Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03818-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chen-ning Liu ◽

Fu-bing Yu ◽

Yun-zhe Xu ◽

Jin-sheng Li ◽

Zhi-hong Guan ◽

...

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Postpartum Hemorrhage ◽

Maternal Age ◽

Placenta Previa ◽

Previous Cesarean Section ◽

Estimated Blood Loss ◽

History Of ◽

Prolonged Labor ◽

Previous Cesarean

Abstract Background Although maternal deaths are rare in developed regions, the morbidity associated with severe postpartum hemorrhage (SPPH) remains a major problem. To determine the prevalence and risk factors of SPPH, we analyzed data of women who gave birth in Guangzhou Medical Centre for Critical Pregnant Women, which received a large quantity of critically ill obstetric patients who were transferred from other hospitals in Southern China. Methods In this study, we conducted a retrospective case-control study to determine the prevalence and risk factors for SPPH among a cohort of women who gave birth after 28 weeks of gestation between January 2015 and August 2019. SPPH was defined as an estimated blood loss ≥1000 mL and total blood transfusion≥4 units. Logistic regression analysis was used to identify independent risk factors for SPPH. Results SPPH was observed in 532 mothers (1.56%) among the total population of 34,178 mothers. Placenta-related problems (55.83%) were the major identified causes of SPPH, while uterine atony without associated retention of placental tissues accounted for 38.91%. The risk factors for SPPH were maternal age < 18 years (adjusted OR [aOR] = 11.52, 95% CI: 1.51–87.62), previous cesarean section (aOR = 2.57, 95% CI: 1.90–3.47), history of postpartum hemorrhage (aOR = 4.94, 95% CI: 2.63–9.29), conception through in vitro fertilization (aOR = 1.78, 95% CI: 1.31–2.43), pre-delivery anemia (aOR = 2.37, 95% CI: 1.88–3.00), stillbirth (aOR = 2.61, 95% CI: 1.02–6.69), prolonged labor (aOR = 5.24, 95% CI: 3.10–8.86), placenta previa (aOR = 9.75, 95% CI: 7.45–12.75), placenta abruption (aOR = 3.85, 95% CI: 1.91–7.76), placenta accrete spectrum (aOR = 8.00, 95% CI: 6.20–10.33), and macrosomia (aOR = 2.30, 95% CI: 1.38–3.83). Conclusion Maternal age < 18 years, previous cesarean section, history of PPH, conception through IVF, pre-delivery anemia, stillbirth, prolonged labor, placenta previa, placental abruption, PAS, and macrosomia were risk factors for SPPH. Extra vigilance during the antenatal and peripartum periods is needed to identify women who have risk factors and enable early intervention to prevent SPPH.

Download Full-text

Vasa previa: a case report

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204329 ◽

2020 ◽

Vol 9 (10) ◽

pp. 4301

Author(s):

Ipsita Mohapatra ◽

Subha R. Samantaray ◽

V. Naga Sindhuja

Keyword(s):

Neonatal Outcome ◽

Placenta Previa ◽

Placental Tissue ◽

Multiple Pregnancies ◽

Lower Segment ◽

Vitro Fertilization ◽

Vasa Previa ◽

History Of ◽

Fetal Vessels

Vasa previa is defined as a condition where fetal vessels traverse the membranes in the lower segment below the presenting part unsupported by placental tissue or umbilical cord. Rupture of the membranes leads to fetal exsanguinations and even neonatal death. The etiology is uncertain, but risk factors include bilobed or succenturiate lobed placenta, velamentous insertion of cord, placenta previa, pregnancies resulting from In vitro fertilization (IVF) and multiple pregnancies. We report here a case of 24 year old woman, G3A2 at 34 weeks of gestation and history of 2 previous spontaneous abortions with vasa previa which was successfully managed. Prenatal sonographic diagnosis has the potential to improve or prevent the poor obstetric and neonatal outcome associated with it.

Download Full-text

Evaluation of the risk factors for antepartum hemorrhage in cases of placenta previa: a retrospective cohort study

Journal of International Medical Research ◽

10.1177/03000605211054706 ◽

2021 ◽

Vol 49 (11) ◽

pp. 030006052110547

Author(s):

Momoko Kuribayashi ◽

Hiroyuki Tsuda ◽

Yumiko Ito ◽

Atsuko Tezuka ◽

Tomoko Ando ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Vaginal Delivery ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Placenta Previa ◽

Significant Risk ◽

Nulliparous Women ◽

Multiparous Women ◽

History Of

Objective The aim of this study was to examine the risk factors for antepartum hemorrhage (APH) in women with placenta previa. Methods In this retrospective cohort study, we analyzed the medical records of 233 women with singleton pregnancies presenting with placenta previa whose deliveries were performed at our hospital between January 2009 and July 2018. Results Of the 233 women included in this study, 130 (55.8%) had APH. In the APH group, the gestational age and neonatal birth weight were significantly lower compared with the no hemorrhage group. Maternal age <30 years and multiparity were identified as significant risk factors for APH in both the univariate and multivariate analyses. Focusing on the previous route of delivery in multiparous women, the risk of APH was significantly higher in multiparous women who had experienced at least one vaginal delivery compared with nulliparous women (adjusted odds ratio (OR): 3.42 [95% confidence interval: 1.83–6.38]). Conclusion We showed that women with placenta previa who were under 30 years old and who had a history of vaginal delivery may be at significant risk of experiencing APH.

Download Full-text