Undiagnosed abnormal postpartum blood loss: Incidence and risk factors

Abstract

BackgroundWe aimed to evaluate the incidence of undiagnosed abnormal postpartum blood loss (UPPBL) after vaginal delivery, identify the risk factors and compare them to those of postpartum haemorrhage (PPH).MethodThe study population included women who participated in a randomized controlled trial of women with singleton low-risk pregnancy who delivered vaginally after 35 weeks’ gestation (n = 3917). Clinical PPH was defined as postpartum blood loss ≥ 500 mL measured by using a collector bag and UPPBL was defined by a peripartum change in haemoglobin ≥ 2 g/dL in the absence of clinical PPH. Risk factors were assessed by multivariate multinomial logistic regression.ResultsThe incidence of UPPBL and PPH was 11.2% and 11.0% of vaginal deliveries, respectively. The median peripartum change in Hb level was comparable between UPPBL and PPH groups (2.5 g/dL interquartile range [2.2–3.0] and 2.4 g/dL IQR [1.5–3.3]). Risk factors specifically associated with UPPBL were Asian geographical origin (adjusted OR [aOR] 2.3, 95% confidence interval [CI] 1.2–4.2; p = 0.009), previous caesarean section (aOR 3.4, 2.1–5.5; p<0.001) and episiotomy (aOR 2.6, 1.8–3.6; p<0.001). Risk factors for both UPPBL and PPH were primiparity, long duration of labour, instrumental delivery and retained placenta.ConclusionUndiagnosed abnormal postpartum blood loss is frequent among women giving birth vaginally and has specific risk factors. The clinical importance of this entity needs further confirmation, and the benefit of systematic or targeted prevention strategies needs to be assessed.

The experience of postpartum bleeding in women with inherited bleeding disorders

“…We highlight a large knowledge gap in identifying secondary postpartum hemorrhage, and this is important because an estimated 1 in 10 women who deliver vaginally experience undiagnosed abnormal postpartum blood loss . While health care professionals should be screening for this, many women do not see a physician in follow‐up until 6 weeks after delivery.…”

“…We highlight a large knowledge gap in identifying secondary postpartum hemorrhage, and this is important because an estimated 1 in 10 women who deliver vaginally experience undiagnosed abnormal postpartum blood loss. 20 While health care professionals should be screening for this, many women do not see a physician in follow-up until 6 weeks after delivery. Therefore, it is important to empower these women to identify abnormal bleeding after they leave the hospital, and we have identified a significant opportunity to educate women about the objective signs of abnormal postpartum bleeding.…”

Maternal death and postpartum hemorrhage in sub‐Saharan Africa – A pilot study in metropolitan Mozambique

“…These findings suggest that awareness among health care providers regarding the importance and detrimental effects of PPH may have been relatively low. Undiagnosed abnormal postpartum blood loss has been found to be frequent (approximately 11%-16%) even in developed countries, as identified by change in parameters after delivery such as hemoglobin (drop of ≥2 gm/d), development of anemia or drop in hematocrit of ≥5% 30. Numbers may be even higher in developing countries where a standard approach to recognition, recording, and management of PPH is lacking.…”

Physiologic childbirth and active management of the third stage of labor: A latent class model of risk for postpartum hemorrhage

“…[38][39][40] Strategies for prevention or quick repair of genital tract trauma should be a priority; 41 as it may be an overlooked driver of blood loss. 42 Finally, encouraging endogenous oxytocin release by assisting with early breastfeeding deserves further study.…”