Evaluation of postpartum anaemia screening to improve anaemia diagnosis and patient care: A prospective non-randomized before-and-after anaemia screening protocol implementation study

Abstract

We assessed the efficacy of a screening protocol for postpartum anaemia diagnosis and treatment in the maternity ward. A prospective non-randomized before-and-after anaemia screening protocol implementation study during two consecutive periods was conducted. Women who were scheduled for vaginal birth were tested for haemoglobin (Hb) before delivery. During the first period (June 29–October 10, 2015; N = 803) Hb was measured postpartum for women with anaemia-related symptoms, postpartum haemorrhage, or pre-delivery severe anaemia (Hb < 8 g/dL; “symptoms” group). During the second period (October 11, 2015–January 27, 2016; N = 755) Hb was also measured in all women with pre-delivery anaemia [i.e., Hb < 10.5 g/dL] (“screening” group). The primary outcomes were the rates of women with (1) postpartum anaemia diagnosis (Hb < 10 g/dL) and (2) administration of parenteral iron sucrose (indicated for postpartum Hb ≤ 9.5 g/dL). The detection rate of postpartum anaemia was higher in the screening group compared with the symptoms group (140 (19%) versus 100 (12%), OR adjusted 2.2 95%CI [1.6–3.0], respectively). The iron sucrose treatment rate was also higher (110 (15%) versus 88 (11%), OR adjusted 2.0 95%CI [1.4–2.7], respectively). A total of 122 women were diagnosed with moderate-severe anaemia in the screening group, 27 of whom (22%) were diagnosed solely due to the screening protocol. The results demonstrated that a routine screening of women with predelivery anaemia for postpartum anaemia led to increased anaemia diagnosis and consequently better medical care.

Markers for undiagnosed type 2 diabetes mellitus during pregnancy—A population‐based retrospective cohort study

“…Unfortunately, these data are not available for the study population. However, in a prospective cohort trial we conducted, we found that 80% of women breastfed more than 30 days in our area …”

Hemoglobin drop following postpartum hemorrhage

“…Treatment with iron sucrose has gained popularity in the past few years, thanks to its superiority over oral iron supplementations in treating postpartum anemia 13 and its high tolerability 8 , 13 . Current official guidelines recommend treating moderate to severe postpartum anemia (i.e., Hb ≤ 9.5 g/dl) with intravenous iron supplements, such as iron sucrose 14 – 16 .…”

“…Understanding the physiologic behavior of Hb drop following delivery allowed us to provide recommendations for Hb monitoring postpartum, for the purpose of anemia detection and treatment. Previously , we demonstrated that routine screening of women with pre-delivery anemia for postpartum anemia led to increased anemia diagnosis and consequently better medical care 8 . Together with the results of the current study, we suggest that Hb levels should be determined after delivery in women with pre-delivery anemia (Hb < 10.5 g/dl) and in women with occult or overt PPH.…”

“…The strengths of this study lay in the prospectively collected data, the high recruitment rate, which decreased selection bias, a large sample size , the use of a systematic protocol to follow Hb decrease until stabilization, and inclusion of both control and occult PPH groups. The limitations of this study included its nature as a secondary analysis, diagnosis of overt bleeding at staff discretion and not by accurate blood loss measurement, and the large percentage of women in the control group with pre-delivery anaemia, due to the design of the original study 8 . The latter limitation was overcome by performing a sub-analysis of women without pre-delivery anaemia and by adjusting the study endpoints for pre-delivery Hb and HCT.…”

“…This was a secondary analysis of data collected in a prospective cohort trial which assessed the efficacy of a routine screening protocol for postpartum anemia diagnosis and treatment in the maternity ward of women who delivered vaginally. The study evaluated two protocols for postpartum anemia detection 8 .…”