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Patterns and predictors of severe postpartum anemia after Cesarean section
Transfusion, 2016
BACKGROUNDPostpartum anemia is associated with maternal and perinatal morbidity. Population‐level data may inform guideline development for postpartum anemia screening. Our objectives were to evaluate the associations between potential predictors (predelivery anemia and postpartum hemorrhage [PPH]) with severe postpartum anemia after Cesarean section.STUDY DESIGN AND METHODSData were collected from 70,939 hospitalizations for Cesarean section performed at Kaiser Permanente Northern California facilities between 2005 and 2013. Severe postpartum anemia was defined as a hemoglobin (Hb) level of less than 8 g/dL before hospital discharge. Using multivariable logistic regression, we assessed the associations between predelivery anemia and PPH with severe postpartum anemia. Distributions of these characteristics among women with severe postpartum anemia were evaluated.RESULTSThe overall rate of severe postpartum anemia was 7.3% (95% confidence interval [CI], 7.1%‐7.4%). Severe postpartum ...
The definition, screening, and treatment of postpartum anemia: A systematic review of guidelines
Birth, 2020
BackgroundPostpartum 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.ObjectiveTo compare global recommendations regarding the appropriate management of postpartum anemia and to highlight similarities and differences.MethodsSystematic 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.ResultsTwo sets of guidelines have been elaborated by in...
Incidence of Postpartum Anemia Among Postpartum Patients in East Jeddah Hospital
International Journal of Pharma and Bio Sciences, 2019
Postpartum anemia (PPA) is an important health problem affecting women at Saudi Arabia, which increase the risk of maternal mortality and morbidity. There are many risk factors which can affect the incidence of postpartum anemia. In our study we shed the light on the incidence and the risk factors associated with this among patients who delivers in EJH. This study is retrospective cohort study for patients delivered at EJH from first of January 2018 to 30 of June 2018. The total number of cases is 1252, who had complete data and others were excluded. However, during the analysis, we just analyzed 250 cases. In our study, we selected definition of PPA is having Hb < 10 g/dl on day 1 after delivery. Our study showed that incidence of PPA is round 60% which is high in comparison with international figure (22-45 %). These findings shed the light on the urgent need to keep PPA monitor to adjust current strategies to control risk factors associated with PPA. There was a significant correlation between postpartum anemia and blood transfusion. Preterm gestational age, cesarean delivery, antenatal anemia were significant independent risk factors for postpartum anemia. It was found that postpartum anemia (PPA) was higher among those delivered through cesarean delivery and low among those delivered through vaginal route. So, we recommended to increase the patient awareness about risks associated with cesarean delivery and to have sufficient control on cesarean delivery by request. Antenatal anemia was significant risk factor for PPA. It might be due to poor nutritional quality of mothers and poor intake of iron therapy. PPA was less associated with postpartum complications as all of these complications due to vaginal deliveries and all cases who needed blood transfusion were diagnosed with postpartum anemia.
Third trimester anemia extends the length of hospital stay after delivery
Turkish journal of obstetrics and gynecology, 2017
To assess the relationship between maternal third trimester anemia and hospital stay after delivery. In this retrospective cross-sectional study, 695 women aged 18-42 years were included between January 2016 and June 2016. Obstetric outcomes and fetal outcomes were measured. Statistical analysis was performed using SPSS, version 19.0 (SPSS, Chicago, Illinois). The prevalence of anemia in this study was 15.2%. The study population was divided into three groups according to hemoglobin (Hb) levels. Group 1 consisted of patients with Hb <8.5 g/dL, group 2 Hb 8.5-11 g/dL, and group 3 Hb >11 g/dL. Higher levels of Hb were associated with shorter stay in hospital (p=0.028). In binary comparison, no significant difference was observed between groups 2 and 3, whereas it was statistically different from group 1. Fetal weight (p=0.562), neonatal intensive care unit admission (p=0.596), APGAR score 1 (p=0.674) and 5 minute (p=0.876), type of delivery (p=0.831), and gestational age (p=0.79...
Investigation of Factors Affecting Postoperative Hemoglobin Decline in Primary Cesarean Sections
European Archives of Medical Research, 2018
The aim of our study was to evaluate the factors affecting postoperative hemoglobin (Hb) decrease in primary cesarean section patients. Methods: A total of 560 patients who underwent primary caesarean section between January 2016 and December 2016 were evaluated retrospectively. These patients were divided into two groups according to postoperative Hb values: patients with Hb decrease ≥2 g/dL or <2 g/dL. There were 142 patients with Hb decrease ≥2 g/dL. Preoperative and postoperative 24 th hour Hb and hematocrit levels, and factors leading to Hb decrease were evaluated. Results: Of the 560 pregnant women included in the study, 289 (51.60%) had emergent caesarean sections, while 271 (48.39%) were elective cesarean sections. Demographic data, distribution of cesarean indications and obstetric characteristics were not different between the two groups. Postoperative erythrocyte transfusion requirement was significantly different between the groups (p<0.001). The development of atony and additional uterotonic requirement were significantly higher in the group with Hb decrease ≥2 g/dL. Conclusion: Postoperative Hb decrease is relatively rare in primary cesarean sections. Although severe blood loss and blood product transfusion are rare, caution should be exercised if there is a risk factor in primary cesarean sections.
Postpartum Period- a Window of Opportunity for Anaemia Correction
Journal of Evidence Based Medicine and Healthcare
BACKGROUND The aim of the study is to determine the prevalence of anaemia after delivery and highlight the need for postpartum anaemia services in India. MATERIALS AND METHODS Women were recruited at admission for delivery; excluded were mothers with non-iron-deficiency anaemia, haematological disease or who had preterm deliveries. Hb levels were measured at admission for delivery and 24-hours postpartum. An estimate of the number of women with Hb less than 10 g/dL that would qualify for parenteral iron therapy was made. Design-Multicenter study. Setting-Obstetric departments of semi-urban, rural and urban hospitals in India. Population-Women ≥18 years old irrespective of date of admission and mode of delivery. RESULTS 221 (67.03%) women had vaginal births, while 466 (32.96%) women had C-sections. The prevalence of severe anaemia, moderate anaemia and mild anaemia increased between the two study points from 0.43% to 1.74% (McNemar=0.021), 8.01% to 11.21% (McNemar=0.0021) and 60.12% to 69.58% (McNemar <0.001), respectively. The proportion of women who did not have anaemia decreased from 31.44% to 17.47% (McNemar <0.001). Hb levels at 24 hours postpartum were lower in 553 women (80.49%). CONCLUSION We showed that the prevalence of mild, moderate and severe anaemia increase after delivery. Furthermore, vaginal birth and C-section are associated with decreases in Hb. The study highlights the need to institutionalise postpartum anaemia correction services in India to reduce postpartum anaemia prevalence and improve the quality of maternal care. Tweetable abstract-The prevalence of mild, moderate and severe anaemia increase after vaginal birth or C-section.
Anaemia is associated with an increased risk for caesarean delivery
International Journal of Gynecology & Obstetrics, 2019
To investigate the association between anemia and cesarean delivery. Methods: A case-control study was conducted in Saad Abu-Alela Hospital in Khartoum, Sudan from March 1 to November 30, 2107. The cases were women who had cesarean delivery; women who delivered vaginally were the controls. Obstetrics history was gathered using a questionnaire. Results: There was no significant difference in age, parity, residence, job, education, and newborn gender between women who delivered by cesarean (n=130) and women who delivered vaginally (n=260). While mean (SD) of the body mass index (29.3 (5.4) kg/m 2 vs 26.3 (5.6) kg/m 2 , P<0.001) was significantly higher, hemoglobin level (103.0 (8.0) g/L vs 107.0 (8.0) g/L, P=0.001) was significantly lower in women who delivered by cesarean compared with women who delivered vaginally. In logistic regression analyses, age, gravidity, occupation, education, history of miscarriage, and newborn gender were not associated with cesarean delivery; overweight (adjusted odds ratio [AOR] 2.30, 95% confidence interval [CI] 1.24-4.26), obesity (AOR 7.17, 95% CI 3.64-14.13) and anemia (AOR 2.45, 95% CI 1.47-4. 11) were associated with cesarean delivery. Conclusion: The significant association between anemia and cesarean delivery has important implications for the prevention and treatment of anemia among these women.
Research Square (Research Square), 2023
Background Most previous clinical studies investigating the connection between prenatal anaemia and postpartum haemorrhage (PPH) have reported con icting results. Objectives We examined the association between maternal prenatal anaemia and the risk of PPH in a large cohort of healthy pregnant women in ve health institutions in Lagos, Southwest Nigeria. Methods This was a prospective cohort analysis of data from the Predict-PPH study that was conducted between January and June 2023. The study enrolled n = 1222 healthy pregnant women giving birth in ve hospitals in Lagos, Nigeria. The study outcome, WHO-de ned PPH, is postpartum blood loss of at least 500 milliliters (mL). We used a multivariable logistic regression model with a backward stepwise conditional approach to examine the association between prenatal anaemia of increasing severity and PPH while adjusting for confounding factors. Results Of the 1222 women recruited to the Predict-PPH study between January and June 2023, 1189 (97•3%) had complete outcome data. Up to 570 (46.6%) of the enrolled women had prenatal anaemia while 442 (37.2%) of those with complete follow-up data had WHO-de ned PPH. After controlling for potential confounding factors, maternal prenatal anaemia was independently associated with PPH (adjusted odds ratio = 1.37, 95% con dence interval: 1.05-1.79). We also recorded no statistically signi cant differences in postpartum blood losses between women without anaemia and across the different categories of women affected by anaemia (P = 0.349). Conclusion Prenatal anaemia regardless of severity increases the risk of PPH in our study cohort. Our ndings have signi cant policy implications, including the need to lower the prevalence of anaemia in resourceconstrained settings like Nigeria by implementing population-level nutritional and educational interventions to improve dietary intake and lower recurrent infections and in ammation among women of reproductive age.