Abstract:Severe postpartum haemorrhages (PPH) are responsible for maternal morbidity/mortality. Their complex management sometimes requires haemostatic supplementation, and therapeutic trials on fibrinogen or activated factor VII, which may add to the thrombotic risk, are currently being considered. Furthermore, there is a risk of venous thromboembolism (VTE) during the postpartum period, hence we studied the relationship between severe PPH and VTE in women during their first pregnancy. Among the 32,463 women enrolled … Show more
“…Citations not in English were screened at this stage using Google translate. A total of 12 papers appeared to meet the inclusion criteria for this review [25–36]; however, at data extraction stage it was realised that we were unable to abstract data from six papers [26, 29, 32–35] because the outcomes reported in these papers all related to management or treatments of PPH, and no maternal physical or emotional health outcomes were reported.Fig. 1Flow diagram of the search and selection process…”
Section: Resultsmentioning
confidence: 99%
“…Detailed characteristics of included papers are presented in Table 3. Five studies reported the outcomes of primary PPH [25, 27, 28, 30, 31] and one reported outcomes after secondary PPH [36]. …”
Section: Resultsmentioning
confidence: 99%
“…Three studies defined PPH in a somewhat similar fashion, including treatment required, e.g., “bleeding … persisting after manual exploration of the uterine cavity and requiring I.V. prostaglandin administration” [25], “findings of pelvic examination, condition of the uterus” [31], “a fall in haemoglobin, for example, to 7 g/dl and/or by 4 g/dl or more” [25, 27]. …”
Section: Resultsmentioning
confidence: 99%
“…The number of reported health problems varied from one (the rate of re-admission at ≥1 but <3 months postpartum [30]), to 31 [27]. Four studies reported health outcomes in the 1st postpartum month [25, 28, 31, 36], two at ≥1 < 3 [27, 30], and one at ≥3 < 6 [27]. Five reported outcomes following primary PPH [25, 27, 28, 30, 31] and one following both primary and secondary PPH [36].…”
Section: Resultsmentioning
confidence: 99%
“…Chauleur et al [25] found that women who experienced PPH were at increased risk of superficial venous thrombosis (adjusted relative risk: 5.3, 95 % CI 1.6 to 17). Hoveyda & MacKenzie [36] analysed data from 657 women with primary PPH and found 33 (5.02 %) had a secondary PPH compared with only 99 out of 18,479 women who did not have primary PPH (0.54 %), giving an odds ratio of 9.3 (95 % CI 6–2 to 14).…”
BackgroundPostpartum Haemorrhage (PPH) is a leading cause of maternal mortality with approximately 225 women dying as a result of it each day especially in low income countries. However, much less is known about morbidity after a PPH. This systematic review aimed to determine the overall prevalence of emotional and physical health problems experienced by women following a postpartum haemorrhage.MethodsEight databases were searched for published non-randomised, observational, including cohort, primary research studies that reported on the prevalence of emotional and/or physical health problems following a PPH. Intervention studies were included and data, if available, were abstracted on the control group. All authors independently screened the papers for inclusion. Of the 2210 papers retrieved, six met the inclusion criteria. Data were extracted independently by two authors. The methodological quality of the included studies was assessed using a modified Newcastle Ottawa Scale (NOS). The primary outcome measure reported was emotional and physical health problems up to 12 months postpartum following a postpartum haemorrhage.ResultsTwo thousand two hundred ten citations were identified and screened with 2089 excluded by title and abstract. Following full-text review of 121 papers, 115 were excluded. The remaining 6 studies were included. All included studies were judged as having strong or moderate methodological quality. Five studies had the sequelae of PPH as their primary focus, and one study focused on morbidity postnatally, from which we could extract data on PPH. Persistent morbidities following PPH (at ≥ 3 and < 6 months postpartum) included postnatal depression (13 %), post-traumatic stress disorder (3 %), and health status ‘much worse than one year ago’ (6 %). Due to the different types of health outcomes reported in the individual studies, it was possible to pool results from only four studies, and only then by accepting the slightly differing definitions of PPH. Those that could be pooled reported rates of acute renal failure (0.33 %), coagulopathy (1.74 %) and re-admission to hospital following a PPH between 1 and 3 months postpartum (3.6 %), an appreciable indication of underlying physical problems.ConclusionThis systematic review demonstrates that the existence and type of physical and emotional health problems post PPH, regardless of the volume of blood lost, are largely unknown. Further large cohort or case control studies are necessary to obtain better knowledge of the sequelae of this debilitating morbidity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1054-1) contains supplementary material, which is available to authorized users.
“…Citations not in English were screened at this stage using Google translate. A total of 12 papers appeared to meet the inclusion criteria for this review [25–36]; however, at data extraction stage it was realised that we were unable to abstract data from six papers [26, 29, 32–35] because the outcomes reported in these papers all related to management or treatments of PPH, and no maternal physical or emotional health outcomes were reported.Fig. 1Flow diagram of the search and selection process…”
Section: Resultsmentioning
confidence: 99%
“…Detailed characteristics of included papers are presented in Table 3. Five studies reported the outcomes of primary PPH [25, 27, 28, 30, 31] and one reported outcomes after secondary PPH [36]. …”
Section: Resultsmentioning
confidence: 99%
“…Three studies defined PPH in a somewhat similar fashion, including treatment required, e.g., “bleeding … persisting after manual exploration of the uterine cavity and requiring I.V. prostaglandin administration” [25], “findings of pelvic examination, condition of the uterus” [31], “a fall in haemoglobin, for example, to 7 g/dl and/or by 4 g/dl or more” [25, 27]. …”
Section: Resultsmentioning
confidence: 99%
“…The number of reported health problems varied from one (the rate of re-admission at ≥1 but <3 months postpartum [30]), to 31 [27]. Four studies reported health outcomes in the 1st postpartum month [25, 28, 31, 36], two at ≥1 < 3 [27, 30], and one at ≥3 < 6 [27]. Five reported outcomes following primary PPH [25, 27, 28, 30, 31] and one following both primary and secondary PPH [36].…”
Section: Resultsmentioning
confidence: 99%
“…Chauleur et al [25] found that women who experienced PPH were at increased risk of superficial venous thrombosis (adjusted relative risk: 5.3, 95 % CI 1.6 to 17). Hoveyda & MacKenzie [36] analysed data from 657 women with primary PPH and found 33 (5.02 %) had a secondary PPH compared with only 99 out of 18,479 women who did not have primary PPH (0.54 %), giving an odds ratio of 9.3 (95 % CI 6–2 to 14).…”
BackgroundPostpartum Haemorrhage (PPH) is a leading cause of maternal mortality with approximately 225 women dying as a result of it each day especially in low income countries. However, much less is known about morbidity after a PPH. This systematic review aimed to determine the overall prevalence of emotional and physical health problems experienced by women following a postpartum haemorrhage.MethodsEight databases were searched for published non-randomised, observational, including cohort, primary research studies that reported on the prevalence of emotional and/or physical health problems following a PPH. Intervention studies were included and data, if available, were abstracted on the control group. All authors independently screened the papers for inclusion. Of the 2210 papers retrieved, six met the inclusion criteria. Data were extracted independently by two authors. The methodological quality of the included studies was assessed using a modified Newcastle Ottawa Scale (NOS). The primary outcome measure reported was emotional and physical health problems up to 12 months postpartum following a postpartum haemorrhage.ResultsTwo thousand two hundred ten citations were identified and screened with 2089 excluded by title and abstract. Following full-text review of 121 papers, 115 were excluded. The remaining 6 studies were included. All included studies were judged as having strong or moderate methodological quality. Five studies had the sequelae of PPH as their primary focus, and one study focused on morbidity postnatally, from which we could extract data on PPH. Persistent morbidities following PPH (at ≥ 3 and < 6 months postpartum) included postnatal depression (13 %), post-traumatic stress disorder (3 %), and health status ‘much worse than one year ago’ (6 %). Due to the different types of health outcomes reported in the individual studies, it was possible to pool results from only four studies, and only then by accepting the slightly differing definitions of PPH. Those that could be pooled reported rates of acute renal failure (0.33 %), coagulopathy (1.74 %) and re-admission to hospital following a PPH between 1 and 3 months postpartum (3.6 %), an appreciable indication of underlying physical problems.ConclusionThis systematic review demonstrates that the existence and type of physical and emotional health problems post PPH, regardless of the volume of blood lost, are largely unknown. Further large cohort or case control studies are necessary to obtain better knowledge of the sequelae of this debilitating morbidity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1054-1) contains supplementary material, which is available to authorized users.
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