Women who experience obstetric haemorrhage are at higher risk of anaemia, in both rich and poor countries

Abstract

Abstractobjectives Anaemia is a potential long-term sequel of obstetric blood loss, but the increased risk of anaemia in women who experience a haemorrhage compared to those who do not has not been quantified. We sought to quantify this risk and explore the duration of increased risk for these women.methods Systematic review of articles published between 1990 and 2009. Data were analysed by highand low-income country groupings. Prevalence and incidence ratios, and mean haemoglobin levels were compared.results Eleven of 822 studies screened were included in the analysis. Most studies showed a higher prevalence or incidence of anaemia in women who had experienced haemorrhage than in those who did not, irrespective of the timing of measurement post-partum. In high-income countries, women who had a haemorrhage were at 5.68 (95% CI 5.04-6.40) times higher risk of post-partum anaemia than women who did not. In low-income countries, the prevalence of anaemia was 1.58 (95% CI 0.96-2.60) times higher in women who had a haemorrhage than in women who did not, although this ratio was greater when the study including mild anaemia in its definition of anaemia was excluded (1.93, 95% CI 1.42-2.62). Population-attributable fractions ranged from 14.9% to 39.6%. Several methodological issues, such as definitions, exclusion criteria and timing of measurements, hindered the comparability of study results.conclusions Women who experience haemorrhage appear to be at increased risk of anaemia for many months after delivery. This important finding could have serious implications for their health care and management.

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

“…Postpartum hemorrhage increases the risk of anemia, which may persist for many months or even years after delivery. 56 Blood loss in the setting of preexisting anemia will undoubtedly worsen underlying iron deficiency, which is a major contributor to anemia in the region, 57 as also shown in our cohort by the high prevalence of microcytosis and hypochromia. Since iron deficiency will be difficult to correct given the prevailing nutritional challenges in sub-Saharan Africa, 58 retrospective observation period, only about a quarter of medical charts were available for review (n = 495).…”

“…Acute blood loss during delivery also affects subsequent well‐being. Postpartum hemorrhage increases the risk of anemia, which may persist for many months or even years after delivery . Blood loss in the setting of preexisting anemia will undoubtedly worsen underlying iron deficiency, which is a major contributor to anemia in the region, as also shown in our cohort by the high prevalence of microcytosis and hypochromia.…”

Incidence of abortion-related near-miss complications in Zambia: cross-sectional study in Central, Copperbelt and Lusaka Provinces

“…We also revised the infection definition for the moderate category and replaced the high-severity category with a near-miss category. We introduced anemia into our classification because hemorrhage is a major complication of unsafe abortion [25], but the PMM does not include in its categories criteria other than shock to assess severity of blood loss. Many women and hospitals are unable to objectively quantify blood loss after an abortion, but it is possible to assess the effect of blood loss by measuring hemoglobin levels in such settings.…”

The prevalence of women’s emotional and physical health problems following a postpartum haemorrhage: a systematic review

“…Wagner et el. [4] describe a review of 11 studies, showing that PPH resulted in anaemia with a summary ratio of 2.35 (95 % CI 1.44–3.84), albeit with considerable heterogeneity. Emotional outcomes occur also, with the majority of women who experience PPH having negative memories of the birth including, for some, a persistent fear of dying [5].…”