The Causes of Postpartum Hemorrhage Leading to Packed-Cell Transfusion

authors:

avatar Aghdas Abdolrazaghnejad 1 , avatar Hossein Ansari 1 , avatar Mohammad Reza Habibollahian 1 , avatar Zeynab Amiriariya 2 , avatar Razieh Mohammadkhani 2 , *

Obstetrics and Gynecology Department, Pregnancy Health Research Center, Ali Ibne Abitaleb Hospital, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
Fertility, Gynecology and Andrology: Vol.3, issue 1; e131093
published online: March 7, 2023
article type: Letter
received: August 22, 2022
revised: January 17, 2023
accepted: January 25, 2023
DOI: https://doi.org/10.5812/fga-131093

how to cite: Abdolrazaghnejad A, Ansari H, Habibollahian M R, Amiriariya Z, Mohammadkhani R. The Causes of Postpartum Hemorrhage Leading to Packed-Cell Transfusion. Fertil Gynecol Androl. 2023;3(1):e131093. https://doi.org/10.5812/fga-131093.

Dear Editor,

Postpartum hemorrhage (PPH) is defined as the loss of more than 500 mL or 1000 mL of blood following vaginal birth or cesarean section, respectively, within the first 24 hours after delivery. Poor uterine tone following childbirth, uterine trauma or rupture, pregnancy products remain, and underlying maternal diseases such as coagulopathy account for the majority of PPH cases (1, 2).

Some procedural factors, including cesarean section delivery, overuse of medical labor induction, instrumental vaginal delivery, curettage, and episiotomy, as well as some women's maternal characteristics, including advanced age, primary gravid, history of previous cesarean section, coagulopathy diseases, obesity, multiple pregnancies, and gestational hypertensive disorders, can increase the risk of PPH (3-6).

Although remarkable developments have taken place in the medical and surgical treatment, PPH is still a leading cause of maternal mortality (7), and its prevalence is unreasonably high, especially in low-income countries. For instance, the prevalence of PPH in lower-income countries has been reported to be 4 to 11 per 1,000 deliveries (8). Prevention and perfect management of PPH can considerably reduce the maternal peripartum morbidity and mortality. To this end, discovering the underlying causes of PPH seems to be the first and most important step to take.

This retrospective and descriptive study investigated 80 pregnant women aged 18 - 38 years with packed cell transfusion indication after the delivery in Ali Ibne Abitaleb Hospital, Zahedan, Iran, in 2017 - 2019.

Among the causes leading to packed cell transfusion in the study population, cesarean section (31.2%) was the most prevalent cause, followed by placenta accreta (15%), abortion (15%), and placenta previa (12.5%). Although there were no significant differences among PPH causes leading to packed cell transfusion in terms of age (P-value = 0.690), women with placenta Previa were the oldest participants, and pregnant women with mole and ectopic pregnancy were the youngest ones.

The reported global incidence of PPH varies greatly according to the country, quality of medical records, estimation methods of blood loss, and discharge time of childbirth women (5, 9, 10). Furthermore, PPH is a major cause of maternal mortality worldwide. Although most of these deaths occur in low-income countries, recent assessments have suggested an increasing trend of PPH in high-income countries (11-13).

Despite the presence of PPH risk, the assessment of blood loss, monitoring women after childbirth, as well as on-time application of packed cells and other blood products can reduce maternal mortality and save 1500 life/year worldwide (14).

According to our study results, moreover, women delivering their babies through cesarean section were more likely to lose blood than women having vaginal births. The current cesarean section delivery, as well as positive history of cesarean section are significant risk factors of PPH due to the increased risk of abnormal placentation, hemorrhage, and peripartum hysterectomy (15, 16).

Although adopting blood transfusions and procedures to control bleeding can be lifesaving, these products are hardly available and extremely expensive. Hence, it is absolutely vital to preserve and apply them appropriately. It was suggested that future studies with longer follow-up of pregnant women should be conducted to investigate different populations with different races/ethnicity and socioeconomic situations.

References

  • 1.

    Feduniw S, Warzecha D, Szymusik I, Wielgos M. Epidemiology, prevention and management of early postpartum hemorrhage - a systematic review. Ginekol Pol. 2020;91(1):38-44. [PubMed ID: 32039467]. https://doi.org/10.5603/GP.2020.0009.

  • 2.

    Sebghati M, Chandraharan E. An update on the risk factors for and management of obstetric haemorrhage. Womens Health (Lond). 2017;13(2):34-40. [PubMed ID: 28681676]. [PubMed Central ID: PMC5557181]. https://doi.org/10.1177/1745505717716860.

  • 3.

    Van den Akker T, Brobbel C, Dekkers OM, Bloemenkamp KWM. Prevalence, indications, risk indicators, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A systematic review and meta-analysis. Obstet Gynecol. 2016;128(6):1281-94. [PubMed ID: 27824773]. https://doi.org/10.1097/AOG.0000000000001736.

  • 4.

    Campbell SM, Corcoran P, Manning E, Greene RA, Irish Maternal Morbidity Advisory G. Peripartum hysterectomy incidence, risk factors and clinical characteristics in Ireland. Eur J Obstet Gynecol Reprod Biol. 2016;207:56-61. [PubMed ID: 27825028]. https://doi.org/10.1016/j.ejogrb.2016.10.008.

  • 5.

    Tiruneh B, Fooladi E, McLelland G, Plummer V. Incidence, mortality, and factors associated with primary postpartum haemorrhage following in-hospital births in northwest Ethiopia. PLoS One. 2022;17(4). e0266345. [PubMed ID: 35385562]. [PubMed Central ID: PMC8986012]. https://doi.org/10.1371/journal.pone.0266345.

  • 6.

    Jakobsson M, Gissler M, Tapper AM. Risk factors for blood transfusion at delivery in Finland. Acta Obstet Gynecol Scand. 2013;92(4):414-20. [PubMed ID: 22708585]. https://doi.org/10.1111/j.1600-0412.2012.01490.x.

  • 7.

    Van Lerberghe W. The World Health Report 2005: Make every mother and child count. Geneva: World Health Organization; 2005.

  • 8.

    Peivandi S, Peivandi S, Habibi A, Atarod Z, Moosazadeh M, Fallah S. Prevalence and factors associated with peripartum hysterectomy among Iranian pregnant women: A retrospective study. Ethiop J Health Sci. 2022;32(2):289-96. [PubMed ID: 35693567]. [PubMed Central ID: PMC9175228]. https://doi.org/10.4314/ejhs.v32i2.9.

  • 9.

    Subramaniyam C, Chandran S, Priya S. Comparative study on prevention of postpartum hemorrhage by routine active management of third stage of labor versus active management of third stage of labor with AMR’S maneuver in Madurai Medical College, Tamil Nadu, India. Int J Sci Study. 2017;5(1):70-3.

  • 10.

    Haeri S, Marcozzi D. Emergency preparedness in obstetrics. Obstet Gynecol. 2015;125(4):959-70. [PubMed ID: 25751222]. https://doi.org/10.1097/AOG.0000000000000750.

  • 11.

    Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle MH, Ford JB, et al. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth. 2009;9:55. [PubMed ID: 19943928]. [PubMed Central ID: PMC2790440]. https://doi.org/10.1186/1471-2393-9-55.

  • 12.

    Holm C, Langhoff-Roos J, Petersen KB, Norgaard A, Diness BR. Severe postpartum haemorrhage and mode of delivery: a retrospective cohort study. BJOG. 2012;119(5):596-604. [PubMed ID: 22313728]. https://doi.org/10.1111/j.1471-0528.2011.03267.x.

  • 13.

    Patterson JA, Roberts CL, Bowen JR, Irving DO, Isbister JP, Morris JM, et al. Blood transfusion during pregnancy, birth, and the postnatal period. Obstet Gynecol. 2014;123(1):126-33. [PubMed ID: 24463672]. https://doi.org/10.1097/AOG.0000000000000054.

  • 14.

    Mitra J, Mitra K, Nandy S, Roy RN, Mandal PK, Biswas R. Utilisation pattern of blood in a teaching hospital of Kolkata. Indian J Public Health. 2004;48(4):205-9. [PubMed ID: 15709577].

  • 15.

    Knight M, Kurinczuk JJ, Spark P, Brocklehurst P, United Kingdom Obstetric Surveillance System Steering C. Cesarean delivery and peripartum hysterectomy. Obstet Gynecol. 2008;111(1):97-105. [PubMed ID: 18165397]. https://doi.org/10.1097/01.AOG.0000296658.83240.6d.

  • 16.

    Daltveit AK, Tollanes MC, Pihlstrom H, Irgens LM. Cesarean delivery and subsequent pregnancies. Obstet Gynecol. 2008;111(6):1327-34. [PubMed ID: 18515516]. https://doi.org/10.1097/AOG.0b013e3181744110.