Postpartum haemorrhage: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data

Kerr, Robert S.; Eckert, Linda O.; Winikoff, Beverly; Durocher, Jill; Meher, Shireen; Fawcus, Sue; Mundle, Shuchita; Mol, B.W.; Arulkumaran, Sabaratnam; Khan, Khalid S.; Wandwabwa, Julius; Kochhar, Sonali; Weeks, Andrew

doi:10.1016/j.vaccine.2016.03.039

Cited by 28 publications

(15 citation statements)

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“…Placenta previa is defined as implantation of the placenta over or near the internal orifices of the cervix after 20 weeks gestation prior to transvaginal or abdominal ultrasonography [ 16 ]. Postpartum haemorrhage (PPH) is defined as the loss of more than 500 ml or 1,000 ml of blood within the first 24 hours after childbirth [ 17 ]. Birth asphyxia is defined as deprivation of baby’s organs or brain from oxygen before, during or just after birth [ 18 ]…”

Section: Methodsmentioning

confidence: 99%

Adverse pregnancy outcomes and imbalance in angiogenic growth mediators and oxidative stress biomarkers is associated with advanced maternal age births: A prospective cohort study in Ghana

et al. 2018

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BackgroundAdvanced maternal age (AMA) has been associated with negative pregnancy outcomes. Oxidative stress (OS) and defective placental dysfunction are contributing factors. This study determined the association between AMA and adverse pregnancy outcomes, OS biomarkers and angiogenic growth mediators (AGMs) in normal pregnancies.MethodsThis prospective cohort study conducted at the Obstetrics and Gynaecology (O&G) Department of the Komfo Anokye Teaching Hospital (KATH) finally included 175 normal pregnant women comprising, 58 AMA (35–45 years), 55 (30–34 years) and 62 optimal childbearing age (20–29 years). Venous blood samples were collected at 28–32 weeks for soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PIGF), 8-epiprostaglandinF2-α (8-epi-PGF2α) and total antioxidant capacity (TAC) assays.ResultsPregnancies of AMA had a significantly higher levels of sFlt-1, 8-epi-PGF2α and 8-epi-PGF2α: PIGF ratio but a reduced level of PIGF, TAC and PIGF: sFlt-1 ratio compared to 20–29 years (p<0.0001). A significant negative correlation between AMA and PIGF (r = -0.294; p = 0.038); TAC (r = -0.215; p = 0.001) and PIGF: sFlt-1 ratio (r = -0.457; p<0.0001) and a positive correlation with sFlt-1 (r = 0.269; p = 0.017), 8-epiPGF2α (r = 0.277; p = 0.029) and 8-epi-PGF2: PIGF ratio (r = 0.461; p<0.0001) levels were observed. The adjusted odds ratio (aOR), and 95% confidence interval, and p value for the significant independent adverse outcomes associated with AMA were emergency caesarean section [21.7 (5.9–121.3), p<00001], elective caesarean section [2.7(0.9–5.8), p = 0.0105], stillbirth [12.6(1.4–82.1), p<0.0001], post-partum haemorrhage [4.3(1.1–18.5), p = 0.0094], preterm delivery [8.2(3.5–28.4), p<0.0001], low birth weight babies [9.7(2.8–29.3), p<0.0001], birth asphyxia [3.8(1.6–12.7), p = 0.0054], Apgar score ≤ 7 after 5 min for babies [10.1(4.7–23.2), p<0.0001], placental abruption [3.5(1.3–8.4), p = 0.0117] and intrauterine growth restriction (IUGR) [4.6(2.3–12.9), p = 0.0001].ConclusionAMA pregnancies correlate with adverse pregnancy outcomes and imbalance in OS biomarkers and AGMs. It is incumbent on health care givers to provide effective antenatal care among AMA mothers as early identification of these imbalance and treatment can prevent adverse pregnancy outcomes.

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Section: Methodsmentioning

confidence: 99%

Adverse pregnancy outcomes and imbalance in angiogenic growth mediators and oxidative stress biomarkers is associated with advanced maternal age births: A prospective cohort study in Ghana

et al. 2018

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“…13 A large cohort study could identify the best proxy outcome for a PPH adverse event, by providing the sensitivity and specificity of numerous measures (e.g. Those needing a blood loss cutoff should use a minimum of 1000 ml, reflecting a level more closely correlated with maternal morbidity.…”

Section: A Definition For Use In Researchmentioning

confidence: 99%

“…Our international working group reached a consensus on this approach for a definition of PPH for research. 13 A large cohort study could identify the best proxy outcome for a PPH adverse event, by providing the sensitivity and specificity of numerous measures (e.g. 500 ml, 1000 ml, units of blood transfused, shock index).…”

Section: A Definition For Use In Researchmentioning

confidence: 99%

Postpartum haemorrhage: a single definition is no longer enough

Kerr

Weeks

2016

BJOG

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“…This varies from the definition used in most published studies, in which PPH is defined as blood loss >500 mL blood . Kerr et al recently recommended that one liter is the proper cutoff to use for research settings …”

Section: Introductionmentioning

confidence: 99%

The duration of the third stage in relation to postpartum hemorrhage

Ast

Goedhart

Luttmer

et al. 2019

Birth

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Introduction In this study, we describe the distribution of placenta delivery and the incidence of postpartum hemorrhage in both spontaneous placental delivery and manual removal of the placenta. Methods A retrospective study was performed of 7603 singleton vaginal deliveries of a gestational age over 32 weeks, registered between September 2011 and 2016. We calculated the incidence of postpartum hemorrhage (≥1000 mL blood loss) per 10‐minute duration of the third stage. The odds ratio for developing postpartum hemorrhage was assessed, adjusted for risk factors. The incidence of postpartum hemorrhage was compared between women that did and did not receive manual removal of placenta. Results The median duration of the third stage was 10 minutes (interquartile range 7‐16 minutes). The median amount of blood loss was 300 mL (200‐400 mL). The overall incidence of postpartum hemorrhage was 8.5%. With every additional 10 minutes of third‐stage duration, the risk of developing postpartum hemorrhage significantly increased. In a third stage longer than 60 minutes, the incidence of postpartum hemorrhage was 21.2% without manual removal of the placenta and 70.3% with manual removal. Conclusions The incidence of postpartum hemorrhage increases significantly from 10 to 19 minutes into the third stage. Women with the removal of the placenta had a significantly higher percentage of postpartum hemorrhage. The optimal timing for manual removal of the placenta should be investigated in a carefully designed randomized controlled trial to examine whether earlier manual removal of placenta lowers the incidence and limits the severity of postpartum hemorrhage.

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Postpartum haemorrhage: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data

Cited by 28 publications

References 32 publications

Adverse pregnancy outcomes and imbalance in angiogenic growth mediators and oxidative stress biomarkers is associated with advanced maternal age births: A prospective cohort study in Ghana

Adverse pregnancy outcomes and imbalance in angiogenic growth mediators and oxidative stress biomarkers is associated with advanced maternal age births: A prospective cohort study in Ghana

Postpartum haemorrhage: a single definition is no longer enough

The duration of the third stage in relation to postpartum hemorrhage

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