Maternal Obesity and Postpartum Hemorrhage

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Disclaimers The Points are not written by the blog author but extracted from article for continuous medical education; Emma Hitt, " Maternal Obesity Increases Risk for Postpartum Hemorrhage", http://www.medscape.org/viewarticle/748707 based on study by Blomberg, Marie, "Maternal Obesity and Risk of Postpartum Hemorrhage", Obstetric & Gynecology, September 2011 - Volume 118 - Issue 3 - p 561–568

1. Maternal obesity seems to be associated with an overall increased risk of postpartum hemorrhage, but risk estimates vary from 7% to 70%

2. The risk for atonic hemorrhage appears to increase rapidly with increasing body mass index (BMI)

Study by , Dr. Blomberg:

1) Data was analyzed rom the population-based Swedish Medical Birth Registry, which includes 1,114,071 women who gave birth to 1 child in Sweden from January 1, 1997, through December 31, 2008.

2) Participants were separated out based on weight, with obesity being classed from I to III.

3) Hemorrhage was defined as loss of more than 1000 mL of blood

4) Type of hemorrhage; retained placenta, uterine atony, laceration in birth canal

Result

1. Prevalence of postpartum hemorrhage increased over the study period

2. There was an increased risk for postpartum hemorrhage for women with a BMI of at least 40 kg/m2 after normal delivery compared with normal-weight women (5.2% vs 4.4%; odds ratio [OR], 1.23; 95% confidence interval [CI]

3. The association was even greater after instrumental delivery for obese vs normal-weight women (13.6% vs 8.8%; OR, 1.69; 95% CI, 1.22 - 2.34).

risk for atonic uterine hemorrhage increased directly with increasing BMI, with a 2-fold increased risk in the heaviest obese group

4. No association was found between maternal obesity and other types of hemorrhage.

5. Maternal obesity also increased the likelihood of heparin-like drug use (OR, 2.86; 95% CI, 2.22 - 3.68).

6. Risk for postpartum hemorrhage after induction of labor was not affected by BMI, regardless of delivery mode.

Study limitation

1. Reliance on International Classification of Diseases codes to define various types of postpartum hemorrhage,

2. Variation in criteria for diagnosis and in method of estimating blood loss,

3. Failure to include oxytocin use and epidural anesthesia as possible confounders.

Conclusion:

1. This new knowledge emphasizes the need for active management after delivery of the placenta

2. Consideration to use prophylactic postpartum uterotonic drug