Relationship between gestational weight gain and amount of postpartum bleeding

Yıl 2020, , 365 - 369, 30.09.2020

Tuğba Kınay , Runa Özelçi , Berna Dilbaz , İnci Kahyaoğlu , Özlem Moraloğlu Tekin

https://doi.org/10.16899/jcm.636511

Öz

Abstract

Background/Aims:To evaluate the effect of gestational weight gain on the amount of postpartum
bleeding.

Methods: An observational study reviewed medical records of with low-risk
singleton pregnancies who delivered vaginally at 37 weeks of gestation or
beyond between May 1 and November 1, 2018 at a tertiary referral center. Demographic
and clinical characteristics were obtained from the medical records. The relationship
between the increased rate in BMI during pregnancy and amount of blood loss in
the postpartum first hour was evaluated. 

Results:A total of 411 women was included in the study. In the study population,
the mean blood loss was 57.3±43.9 ml in the 3^rd stage of labor and
113.2±76.9 ml in the postpartum first hour. No correlation was found between
the increase in BMI during pregnancy and blood loss during the 3^rd stage
of labor (r=0.006) and postpartum first hour (r=0.037). Nulliparity, history of
postpartum hemorrhage in previous pregnancy, premature rupture of membranes, and
episiotomy were found to be risk factors for increased postpartum blood loss during
the 1^st hour (p< 0.05). 

Conclusions: Increase in BMI was not related with the amount
of postpartum bleeding in women with low-risk pregnancy who had a vaginal
delivery. 

Anahtar Kelimeler

Postpartum hemorrhage, gestational weight gain, body mass index, nulliparity, episiotomy

Kaynakça

• Wetta LA, Szychowski JM, Seals S, Mancuso MS, Biggio JR, Tita AT. Risk Factors for Uterine Atony/Postpartum Hemorrhage Requiring Treatment after Vaginal Delivery. Am J Obstet Gynecol. 2013; 209(1): 51.e1–51.e6.
• Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B. Prevalence and risk factors of severe obstetric haemorrhage. BJOG. 2008;115(10):1265-72
• Zwart JJ, Richters LM, Ory F, de Vries JI, Bloemenkamp KW, van Roosmalen J. Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: A nationawide population based study of 371,000 pregnancies. BJOG. 2008; 115(7):842-50.
• Lee HJ, Lee YJ, Ahn EH, et al. Risk factors for massive postpartum bleeding in pregnancies in which incomplete placenta previa are located on the posterior uterine wall. Obstet Gynecol Sci. 2017;60(6):520-6.
• Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United States, 1994– 2006. Am J Obstet Gynecol. 2010; 202:353.e1–353.e6.
• Joseph KS, Rouleau J, Kramer MS, Young DC, Liston RM, Baskett TF. Maternal Health Study Group of the Canadian Perinatal Surveillance System. Investigation of an increase in postpartum haemorrhage in Canada. BJOG. 2007; 114(6):751–9.
• Fyfe EM, Thompson JM, Anderson NH, Groom KM, McCowan LM. Maternal obesity and postpartum haemorrhage after vaginal and caesarean delivery among nulliparous women at term: a retrospective cohort study.BMC Pregnancy and Childbirth. 2012; 12:112
• Enomoto K, Aoki S, Toma R, Fujiwara K, Sakamaki K, Hirahara F. Pregnancy Outcomes Based on Pre-Pregnancy Body Mass Index in Japanese Women.PLoS One. 2016;11(6):e0157081.
• WHO. Physical Status: The Use and Interpretation of Anthropometry: Report of a World Health Organization (WHO) Expert Committee. Geneva, Switzerland: World Health Organization; 1995. Blomberg M. Maternal obesity and risk of postpartum hemorrhage. Obstet Gynecol. 2011;118(3):561-8.
• World Health Organisation. Obesity and overweight. Available at https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed May 26 2019.
• Gaillard R, Durmus B, Hofman A, Mackenbach JP, Steegers EA, Jaddoe VW. Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy. Obesity (Silver Spring).2013; 21(5):1046–55.
• Li C, Liu Y, Zhang W. Joint and Independent Associations of Gestational Weight Gain and Pre-Pregnancy Body Mass Index with Outcomes of Pregnancy in Chinese Women: A Retrospective Cohort Study. PLoS One. 2015;10(8):e0136850.
• Kominiarek MA, Seligman NS, Dolin C, et al. Gestational Weight Gain and Obesity: Is 20 Pounds Too Much? Am J Obstet Gynecol. 2013; 209(3): 214.e1–214.e11.
• Blum J, Winikoff B, Raghavan S, et al. Treatment of post-partum haemorrhage with sublingual misoprostol versus oxytocin in women receiving prophylactic oxytocin: a double-blind, randomised, non-inferiority trial.Lancet. 2010;375 (9710):217-23.
• Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22(6): 999–1012.
• Heslehurst N, Simpson H, Ells LJ, et al. The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev 2008, 9(6):635–683.
• Sebire NJ, Jolly M, Harris JP, et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001, 25(8):1175–82.
• Rasmussen KM, Yaktine AL. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: National Academies Press; 2009.
• Driessen M, Bouvier-Colle M-H, Dupont C, et al. Postpartum haemorrhage resulting from uterine atony after vaginal delivery: factors associated with severity. Obstet Gynecol 2011;117(1): 21–31.
• Bateman BT, Berman MF, Riley LE, Leffert LR. The Epidemiology of Postpartum Hemorrhage in A Large, Nationwide Sample of Deliveries. Anesth Analg. 2010; 110(5):1368–73.
• Buzaglo N, Harlev A, Sergienko R, Sheiner E. Risk factors for early postpartum hemorrhage (PPH) in the first vaginal delivery, and obstetrical outcomes in subsequent pregnancy. J Matern Fetal Neonatal Med. 2015;28(8):932-7.
• Oguz Orhan E, Dilbaz B, Aksakal SE, Altınbas S, Erkaya S. Prospective randomized trial of oxytocin administration for active management of the third stage of labor. Int J Gynaecol Obstet. 2014;127(2):175-9.
• Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev. 2017 8;2:CD000081. doi: 10.1002/14651858.CD000081.pub3.
• Stafford I, Dildy GA, Clark SL, Belfort MA. Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol. 2008;199(5):519.e1-7
• Özdilek R, Dutucu N, Coşkun AM. Postpartum Kanama Miktarını Tahminde Gerçeğe Ne Kadar Yaklaşıyoruz? Sağlık Bilimleri ve Meslekleri Dergisi. 2019; 6(1):84-90.