Steep haemoglobin drops in women with postpartum haemorrhage
23 Dec 2020
It was speculated that the family’s wish for a second child in a short period of time might be the reason why they allegedly refused permission for a C-section delivery.Women with postpartum haemorrhage (PPH) experience greater haemoglobin (Hb) reduction than those without PPH, a recent study has found.
“Hb levels should be monitored for at least 48 hours after delivery to detect anaemia requiring iron sucrose treatment and/or blood transfusion,” the researchers said.
The study included 419 women who had complete blood counts taken before and after delivery. Sixty-four percent (n=248) of the participants had bleeding-related complications, and were designated as the PPH group; the remaining 36 percent (n=151) were set as controls. In the PPH group, 158 had occult PPH, and 110 had overt PPH.
In the immediate postpartum period, women with PPH experienced a significantly greater drop in mean Hb than controls (2.4±1.6 vs 0.9±1.0 g/dL; p<0.0001). Haematocrit (HCT) showed the same trend (7±4 percent vs 3±3 percent; p<0.0001).
Moreover, Hb reductions of ≥2 g/dL (odds ratio [OR], 5.6, 95 percent confidence interval [CI], 3.1–10.2) and ≥3 g/dL (OR, 8.6, 95 percent CI, 3.3–22.3) were significantly more likely to occur in participants with PPH.
Sub-analysis according to the type of PPH showed that Hb reductions were greater for overt than occult PPH patients (3.0±1.6 vs 2.0±1.4 g/dL). Similarly, HCT decreases in women with occult PPH fell in between controls and overt PPH patients. Nevertheless, women with either PPH subtype experienced significantly greater reductions in both markers (p<0.0001 for both).
In all groups, the researchers observed that the rate of Hb decline peaked 6–12 hours postpartum and plateaued at 24–48 hours.