25 research outputs found
Massive transfusion in relation to obstetric hemorrhage : with special attention to placenta accreta
The overall purpose of this thesis was to assess risk factors, incidences, and complications of
massive blood transfusions in relation to obstetric hemorrhage postpartum. Obstetric
hemorrhage requiring blood transfusion postpartum has recently shown an increasing trend in
many high resource countries. Massive transfusion, defined as more than 10 units of RBC
within 24 hours is well described in surgery and trauma care, however little is known about
its occurrence and risk factors in obstetric patients. Most blood transfusions are safe and
necessary, but there are potential complications, including transfusion reactions, transfusion
transmitted infections, and post transfusion thrombosis, which have to be taken into
consideration when choosing between blood transfusion and other alternatives. The
increasing rate of cesarean deliveries since the 1970’s, has contributed to complications in
sequential pregnancies. One of the more severe complications is abnormally invasive
placenta, a condition with a high risk of requiring massive blood transfusion and peripartum
hysterectomy.
In Study 1, the incidence, risk factors, and rate of antenatal detection of abnormally invasive
placenta in the Nordic countries were investigated. The study was conducted as a Nordic
collaboration from 2009 to 2012, and included 605,000 deliveries. Cases of abnormally
invasive placenta were reported on a monthly basis directly from maternity wards, and were
complemented with data from the National Health Registries to confirm or to identify
missing cases. In total, 205 cases of invasive placentas associated with a laparotomy were
identified, corresponding to a prevalence of 3.4 per 10,000 deliveries. Major risk factors were
placenta previa (OR = 290) and prior cesarean section (OR = 7). Only one third of the cases
identified as invasive placentas were detected antenatally, and among those cases not
detected, more than one third had had a prior cesarean section.
Study 2 was a retrospective population-based cohort study investigating risk factors,
incidence, and trends over time for massive blood transfusion in women who gave birth in the
County of Stockholm between 1990 and 2011. Data from the Medical Birth Registry was
cross-linked to the Stockholm Transfusion Database. Massive transfusion was defined as
transfusion of >10 units of red blood cells from time of partus through the next day.
Altogether 517,874 pregnancies were included. The study found the incidence of massive
transfusion to be 5.3 per 10,000 deliveries and showed an increasing trend over time. Major
antenatal risk factors were abnormal placentation (OR = 41) and prior cesarean section (OR =
4).
Study 3 was a retrospective cohort study investigating whether postpartum hemorrhage and
red blood transfusion are significant and independent major risk factors for venous
thromboembolism postpartum. Women who gave birth between 1999 and 2002 in the
Stockholm region were included in the study. A time period before the implementation of
national thromboprophylaxis guidelines was chosen. Data from the Medical Birth Registry
was linked to the transfusion database and to the National Discharge Registry. Among 82,376
deliveries 56 cases of venous thromboembolism were identified. The study found transfusion
of red blood cells postpartum (OR = 5) - but not postpartum hemorrhage without blood
transfusion - to be a significant major risk factor for venous thromboembolism postpartum.
In Study 4 the aim was to assess the risk of transfusion reactions in women receiving
postpartum blood transfusion. This populations based cohort study is based on the same
cohort as Study 2. Data on pregnancies from the Medical Birth Registry was linked to the
Stockholm Transfusion Database. Women with postpartum blood transfusion and a
transfusion reaction within seven days from partus were identified. The study found a twofold
increased risk (OR = 2.0) of a transfusion reaction in women postpartum compared to
non-pregnant women receiving a blood transfusion. Among all women who had a blood
transfusion postpartum, women with preeclampsia were twice as likely to have a transfusion
reaction.
In summary, abnormally invasive placenta occurs in 3.4 out of 10,000 deliveries and is the
major risk factor for massive blood transfusion postpartum. A reduction in the rate of
cesarean deliveries might be the best way to lower the incidence of both invasive placenta
and massive blood transfusion postpartum. A focused ultrasound in pregnant women with a
placenta previa or a low-lying placenta covering the scar of a previous cesarean section might
improve antenatal detection of abnormally invasive placentas and allow better planning for
delivery, thereby reducing maternal morbidity in those complicated pregnancies.
Postpartum blood transfusion and especially massive blood transfusion are independent major
risk factors for postpartum thromboembolism. As such, they should be implemented in the
Swedish thromboprophylactic guidelines during pregnancy. The risk of transfusion reactions
in women during pregnancy seems to be increased, especially in pregnancies complicated by
preeclampsia. Therefore, a heightened attention is recommended to women with
preeclampsia when a blood transfusion is to be administrated
Authors' reply re: Abnormally invasive placenta - Prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries
Mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour : A retrospective cohort study of nulliparous women
OBJECTIVE: To investigate the mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour in nulliparous women. METHODS AND FINDINGS: A retrospective cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. The passive second stage was defined as the complete dilation of the cervix until the start of the active second stage. The duration of the passive second stage was categorized into three groups: 0 to 119 min (0 to 2h) of the passive second stage in nulliparous women, although most of the women gave birth by spontaneous vaginal delivery even after ≥4 hours. There was no evidence of an increased risk of adverse maternal outcomes in a longer duration of the passive second stage but there were indications of increased adverse neonatal outcomes. Assessment of fetal well-being is important when the duration of the passive phase is prolonged
Prolonged passive second stage of labor in nulliparous women—Prevalence and risk factors : A historical cohort study
Introduction: This study examined the prevalence of and risk factors for a prolonged passive second stage of labor in nulliparous women. Material and Methods: This was a historical cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. Duration of the passive second stage was measured as time from retracted cervix to start of pushing. Prolonged passive second stage was defined as ≥2 h. Prevalence was calculated and associations between prolonged passive second stage and maternal, obstetric and neonatal characteristics and potential risk factors were assessed using logistic regression models. Results: The prevalence of prolonged passive second stage was 37.6%. Factors associated with an increased risk of prolonged passive second stage were epidural analgesia (adjusted odds ratio [aOR] 3.93; 95% confidence interval [CI] 2.90–5.34), malpresentation (aOR 2.26; 95% CI 1.27–4.05), maternal age ≥ 30 years (aOR 2.00; 95% CI 1.50–2.65) and birth weight ≥ 4 kg (aOR 1.50; 95% CI 1.05–2.15). Maternal body mass index ≥30 (aOR 0.52; 95% CI 0.34–0.79) and noncohabiting (aOR 0.51; 95% CI 0.30–0.89) reduced the odds of prolonged passive second stage. Conclusions: A prolonged passive second stage of labor in nulliparous women is common (n = 425 [38%]). We found epidural analgesia, malpresentation, maternal age ≥ 30 years and birthweight ≥4 kg to be major risk factors associated with an increased risk of a prolonged passive second stage. Birth outcomes for prolonged passive second stage need to be investigated to strengthen evidence for the management of the second stage of labor
Histogram of negative birth experience in relation to mode of delivery.
Histogram of negative birth experience in relation to mode of delivery.</p
Histogram of PPH in relation to mode of delivery.
Histogram of PPH in relation to mode of delivery.</p
Mode of delivery in relation to the duration of the passive second stage.
Mode of delivery in relation to the duration of the passive second stage.</p
STROBE statement—checklist of items that should be included in reports of <i>cohort studies</i>.
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Histogram of intra or post-partum infection in relation to mode of delivery.
Histogram of intra or post-partum infection in relation to mode of delivery.</p