Maternal Obesity Linked to Postpartum Hemorrhage (printer-friendly

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Maternal Obesity Linked to Postpartum Hemorrhage
Emma Hitt, PhD

August 29, 2011 — In postpartum women, the risk for atonic hemorrhage appears to increase rapidly with increasing body mass index (BMI), new research findings suggest. Marie Blomberg, MD, PhD, from the Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden, reported the findings in the September issue of Obstetrics & Gynecology. "Maternal obesity seems to be associated with an overall increased risk of postpartum hemorrhage, but risk estimates vary considerably," from 7% to 70%, Dr. Blomberg writes. She adds that "an increased trend in the incidence of postpartum hemorrhage over time has been observed in high-resource countries, but the reason for this increase remains uncertain." To evaluate this issue, Dr. Blomberg analyzed data from the population-based Swedish Medical Birth Registry, which includes 1,114,071 women who gave birth to 1 child in Sweden from January 1, 1997, through December 31, 2008. Participants were separated out based on weight, with obesity being classed from I to III. Hemorrhage was defined as loss of more than 1000 mL of blood. Types of postpartum hemorrhage considered included those with retained placenta, those attributable to atonic uterus, and those caused by lacerations in the birth canal. The prevalence of postpartum hemorrhage increased over the study period. The risk for atonic uterine hemorrhage increased directly with increasing BMI, with a 2-fold increased risk in the heaviest obese group. No association was found between maternal obesity and other types of hemorrhage. There was an increased risk for postpartum hemorrhage for women with a BMI of at least 40 kg/m after normal delivery compared with normal-weight women (5.2% vs 4.4%; odds ratio [OR], 1.23; 95% confidence interval [CI], 1.04 - 1.45), and the association was even greater after instrumental delivery for obese vs normal-weight women (13.6% vs 8.8%; OR, 1.69; 95% CI, 1.22 - 2.34). Maternal obesity also increased the likelihood of heparin-like drug use (OR, 2.86; 95% CI, 2.22 - 3.68). These findings "have certain important clinical implications," Dr. Blomberg concludes. "This new knowledge emphasizes the need for active management after delivery of the placenta," she adds. "The risk for postpartum hemorrhage after vaginal delivery differs if the woman is lean or obese, which also motivates a more stringent management of obese women." No explanation was given for the potential cause for the association between obesity and increased atonic hemorrhage. The study was not commercially funded. The author has disclosed no relevant financial relationships. Obstet Gynecol. 2011;118:561-568. Abstract
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