1st Journal Reading

Maternal heart rate during the first 48 h postpartum: a

retrospective cross sectional study

Raissa Nurwany

Moderator:
Dr. Hj. Hartati, SpOG (K)

Assessor :
Prof. dr. H. Syakroni Daud Rusydi, SpOG(K)
Dr. H. Azhari, SpOG(K)
Dr. K.H. Yusuf Effendi, SpOG (K)

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2
INTRODUCTION

Return to baseline
weeks to months Multifactor
postpartum

Increase
Maternal HR

Pregnancy and
Puerperium

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 STUDY AIMS

Describe the distribution of heart rate in the first 48h

postpartum (at 6, 12, 24 and 48h post-delivery), in women
with no evidence of sepsis, hemorrhage or anemia.

Investigate the relationship between postpartum heart rate

and other maternal factors (maternal BMI at booking,
maternal age, method of delivery, puerperal blood loss,
discharge haemoglobin and length of hospital stay).

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 MATERIAL AND METHODS

Study Design: Retrospective cross sectional data were collected from

all women who delivered on consultant led obstetric unit at Saint
Mary’s Hospital, Manchester (July 2012-June 2015)

Data Source:
- Maternal database (Patientrack): Maternal age and BMI, puerperal blood loss,
method of delivery, discharge Hb and length of hospital stay.
- Electronic vital sign : Temp and HR observations at 6, 12, 24 and 48 h postpartum

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 MATERIAL AND METHODS
Exclusion criteria:
- Women delivering on the midwifery lead unit.
- All women in whom tachycardia may have been due to sepsis, hemorrhage
or anemia Data grouping :
BMI :
- Underweight
- Healthy Statistical analyses :
- Overweight IBM SPSS Statistic 22
- Obese I
- Obese II
- Obese III

Delivery method:
- Spontaneous vaginal delivery
- Caesarean section 6
RESULTS

7627 HR
from 5164
women 16840
final HR from
analytic 11401
women

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DISTRIBUTION OF HEART RATE

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 TABEL 1. MEAN (μ) AND STANDARD DEVIATION (SD) OF
MATERNAL HEART RATE A 6, 12, 24 AND 48 H POSTPARTUM IN
THE INCLUDED AND EXCLUDED COHORTS.
Excluded cohort
Included Cohort
Post partum (h) Temp >38,3, <36 C Blood loss ≥ 1000 ml Discharge Hb < 100g/dl

N μHR (bpm)± SD N μHR (bpm)± SD N μHR(bpm)± SD N μHR (bpm)± SD

6 267 83,6±12,3 214 82,4±13,7 382 85,0±13,7 148 86,0±14,3

7 4 6
12 263 85,5±12,5 191 83,4±13,7 486 87,2±13,9 150 87,9±14,5
0 3 2
24 189 85,4±12,5 150 86,7±14,2 505 90,3±14,3 143 90,8±14,2
6 7 4
48 424 84,3±12,7 367 85,5±12,6 169 88,5±13,4 485 88,6±12,7

Total 762 84,4±12,5 593 84,0±13,9 15442 87,8±14,1 490 88,2±14,3

7 1 7

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 TABEL 2. MEAN (μ), STANDARD DEVIATION (SD) AND
UPPER LIMIT OF NORMAL (M + 2SD, M + 3SD) MATERNAL
HEART RATE AT 6, 12, 24 AND 48 H POSTPARTUM.
n Mean HR (bpm) μ SD P value μ + 2SD μ + 3 SD
Time after delivery (h) 6 267 83,6 12, <0,001 108,2 120,6
7 3
12 263 84,5 12, 109,4 121,9
0 5
24 189 85,4 12, 122,9 122,9
6 5
48 424 84,3 12, 122,4 122,4
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Total 762 84,4 12, 109,3 121,8
7 5

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 TABEL 3. BASELINE CHARACTERISTICS OF
WOMEN SPLIT INTO COHORTS
ACCORDING TO HOURS POSTPARTUM.

Hours post partum P value

Variable N
6 12 24 48

Age (years) 762 29,9±5,6 29,9±5,6 30,0±5,6 30,4±6,1 0,273

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BMI (kg/m2) 743 26,0±6,4 26,0±6,4 25,9±6,5 25,9±6,4 0,881
6
Method of delivey Non-instrumental vaginal 399 1391(52,0 1432(54,4 985(52,0) 191(45,0) 0,020
9 ) )
Caesarean section 253 911 (34,0) 833(31,7) 627(33,1) 163(38,4)
4
Instrumental vaginal 109 375 (14,0) 365(13,9) 284(15,0) 70(16,5)
4
Puerperal blood loss (ml) 762 286±234 288±234 294±240 305±240 0,324
7
Discharge Hb (g/dl) 507 114±10 114±10 114±10 112±9 0,009
1

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TABEL 4. THE OBSERVED EFFECT OF POTENTIALLY CONFOUNDING
FACTORS (BODY MASS INDEX, MATERNAL AGE, PUERPERAL BLOOD
LOSS, DISCHARGE HAEMOGLOBIN, METHOD OF DELIVERY AND
LENGTH OF STAY) ON MEAN (M) POSTPARTUM HEART RATE BETWEEN
6 AND 48 H.

Variables N Mean HR (bpm) μ P value

BMI (kg/m2) <18,5 (underweight) 304 83,2 <0,001
18,5-24,9 (ideal 305 83,2
weight) 1
25-29,9 (overweight) 228 84,9
4
30-34,9 (obese I) 1158 86,3
35-39,9 (obese II) 443 85,1
≥40 (obese III) 196 87,9
Maternal age <20 247 86,7 <0,001
(years)
20-29 330 85,1
0
30-39 373 83,6
4
≥40 346 84,4
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 TABEL 4. THE OBSERVED EFFECT OF POTENTIALLY CONFOUNDING
FACTORS (BODY MASS INDEX, MATERNAL AGE, PUERPERAL BLOOD
LOSS, DISCHARGE HAEMOGLOBIN, METHOD OF DELIVERY AND
LENGTH OF STAY) ON MEAN (M) POSTPARTUM HEART RATE BETWEEN
6 AND 48 H.

Variables N Mean HR (bpm) μ P value

Puerperal blood loss (ml) ≤100 2278 85,1 <0,001
100- 891 82,6
199
200- 1298 83,4
299
300- 1094 83,9
399
400- 983 84,7
499
500- 468 86,3
599
600- 277 84,8
699
700- 234 85,6
799
800- 99 86,1
899 13
TABEL 4. THE OBSERVED EFFECT OF POTENTIALLY CONFOUNDING
FACTORS (BODY MASS INDEX, MATERNAL AGE, PUERPERAL BLOOD
LOSS, DISCHARGE HAEMOGLOBIN, METHOD OF DELIVERY AND
LENGTH OF STAY) ON MEAN (M) POSTPARTUM HEART RATE BETWEEN
6 AND 48 H.

Variables N Mean HR (bpm) μ P value

Discharge haemoglobin 100-109 217 85,7 0,044
(g/dl 5
110-119 169 84,5
4
120-129 832 85,2
130-139 294 84,1
140-149 61 84,1
≥150 15 87,7
Method of delivery Non-instrumental 399 83,9 0,002
vaginal 9
Caesarean section 253 84,7
4
Instrumental vaginal 109 85,5
4

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TABEL 4. THE OBSERVED EFFECT OF POTENTIALLY CONFOUNDING
FACTORS (BODY MASS INDEX, MATERNAL AGE, PUERPERAL BLOOD
LOSS, DISCHARGE HAEMOGLOBIN, METHOD OF DELIVERY AND
LENGTH OF STAY) ON MEAN (M) POSTPARTUM HEART RATE BETWEEN
6 AND 48 H.

Variables N Mean HR (bpm) μ P value

Length of stays (days) 1 2180 83,1 <0,001
2 2047 84,0
3 1224 85,4
4 757 85,3
5 510 85,7
6 329 85,2
≥7 580 85,7
Total 7627 84,4

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 RESULTS

Mean heart rate (+2SD/+3SD) at 6 h was 83.6 (108.2/120.6), 12 h

84.5 (109.4/121.9), 24 h 85.4 (110.4/122.9), and 48 h 84.3
(109.7/122.4).

There was statistical correlation of post partum heart rate with

body mass index (BMI), age and discharge hemoglobin.

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 COMMENTS

Large study describe distribution of HR in the first 48h postpartum in

women with no evidence of sepsis, haemorrhage or anemia

The differences in HR are small and not clinically meaningful

The first 48 h after delivery represents a time when significant

maternal morbidity and mortality can occur.

Our data showed a positive correlation between BMI and heart rate
The significantly lower HR in those having normal vaginal deliveries,
compared to both SC and instrumental deliveries, represent a reduced blood
loss

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 STUDY STRENGTHS

The first to describe maternal heart rate in the early postpartum

period.

This large dataset enabled identification of significant differences in

heart rate between several subgroups of postpartum women

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 STUDY LIMITATIONS
The study has not yet been correlated with outcome measures i.e. morbidity
or mortality.
Each heart rate reading was treated separately
Whilst the study’s dataset size is a strength, it meant statistically significant
differences between groups were identified despite small margins.
Data were collected retrospectively, thus with no standard way of measuring
heart rate identified
Use of medication at the time the heart rates were recorded was not
considered
All women in the study came from one tertiary centre for obstetrics, where
women with pre-existing medical conditions may be overrepresented

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 CONCLUSION

This study describes the distribution of maternal HR in the early postpartum

period, in women with no evidence of sepsis, anaemia or major haemorrhage.

This will facilitate identification and appropriate investigation of women

with abnormal heart rates.

Although correlation with BMI, age and discharge haemoglobin was

demonstrated, the differences were small and not clinically meaningful.

Further work investigating the relationship between postpartum heart rate

and poor maternal outcomes is required.

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 CRITICAL APPRAISAL

Questions Explanation
Study design, survey or A retrospective cross-sectional study
registration?
Inductive or deductive This journal uses inductive
reasoning? The journal is doing some analysis of
new data then be concluded according to
the results of analysis
 CRITICAL APPRAISAL
Questions Explanation
Type and scales of each Dependent variables: Maternal Heart
variables in this study Rate

Independent Variables:
1. Maternal age
2. Maternal BMI at booking
3. Puerperal Blood Loss
4. Methods of Delivery
5. Discharge hemoglobin
6. Lenghts of hospital stay
 CRITICAL APPRAISAL

Questions Explanation
Type of data, primary, This study was collected data from
secondary or tertiary secondary resources
resources?
Group or ungroup data? Group data
 CRITICAL APPRAISAL

Questions Explanation
Tables that was used to Table 1-4 used to show results of study
present results of this
study
Graph used in this Histogram show distribution of heart
paper rate each period time

Quality of research Quality of research data is good

data enough. the data derived from
recording database patient-rack and
 CRITICAL APPRAISAL

Questions Explanation

Bias There is no bias in this study

Sample size calculation The study included 16840 HR readings

for this study from 11401 women, and 7627 HR
readings from 5164 women for final
analytic
Sampling technique Consecutive sampling
 CRITICAL APPRAISAL

Questions Explanation

Statistical analysis Statistical analyses were performed using

IBM1 SPSS1 Statis- tics 22 (The
International Business Machines
Corporation1, New York, NY, USA).

Error to conclude There is no conclude error statistical

statistical analysis analysis in results
results
 CRITICAL APPRAISAL

Question Answer
How was the presentation Writers explained background, methods
of results in this paper? and results in this study clear enough.
They explained study strengths and
limitation of this study.
But there is no information about the
confident interval (CI) used.
From table 4, puerperal blood loss and
length of stay shown significant result
(p <0,001) while in the discussion part
not said so.
Did they use media for Yes
biostatic analysis
THANK YOU
PATIENTRACK

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