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Association between Gestational Age and Intrapartum Hemorrhage during Cesarean Delivery
Abstract Number: F4A-4
Abstract Type: Original Research
Obstetric hemorrhage is one of the leading causes of maternal mortality. Outcomes are suboptimal despite proactive protocols. For a successful outcome, the protocols must be accurate and revised with new information. No study has analyzed association between gestational age (GA) and hemorrhage. This study is aimed to determine the relationship of obstetric hemorrhage and GA so that resources can be appropriately directed.
Medical records of parturients who underwent cesarean delivery (CD) at our Institution from May 2015 to Dec 2017 were retrospectively reviewed from the EPIC system. Demographic, anesthesia and obstetric data and predisposing factors for hemorrhage were analyzed. The patients were divided into two groups based on the GA: Group 1 with GA ≤ 35 weeks and Group 2 with GA > 35 weeks. The primary outcome was differences in blood loss (BL) and blood administration. Multivariate analysis, Chi-square test, Fisher’s exact test, and Wilcoxon rank-sum test were used for statistical analysis.
4565 parturients were analyzed. There was significant association between placenta previa, placenta accreta, HELLP, coagulation deficits, eclampsia and BL. In the sub cohort of parturients undergoing primary CD without above factors (n=2577), the BL was higher in Group 2 (800 (700-900) v.s. 700 (600-800) ml, P < 0.0001), and GA positively correlated with the BL (1 day increase in GA increases BL by 0.65%, P < 0.0001). This finding was not observed in the repeat CD (n=1668). In the sub cohort of parturients with placenta previa undergoing primary CD (n=122), the BL and the incidence of blood administration were both less in Group 2 (800 (800-1000) v.s. 1300 (1000-1925) ml; 6.2% v.s. 38.5%; P = 0.0001, respectively), and GA was negatively associated with BL after adjusting for other factors (one day increase in GA decreases BL by 1.2%, P < 0.0001).
Although anecdotal hemorrhages are known to occur in all gestations of pregnancy, the findings of this study are important to optimally direct resources, when limited. Our study demonstrates that later GA was associated with greater intrapartum hemorrhage in primary CD, consequent to increased stretching of uterine muscle fibers, uterine blood flow and uterine vascularity. Hence, preparatory measures for obstetric hemorrhage in early gestation need not to be as intensive as term gestation for primary CD. An exception is placenta previa. Early GA is associated with higher BL, and this is most likely due to uterine incision being near proximity to placenta previa.
In addition to well established predisposing factors, GA is an important factor in determining the extent of obstetric hemorrhage during cesarean delivery.
1. Womens Health (Lond). 2017; 13(2): 34-40.
2. Obstet Gynecol. 2017; 130(5): 1143-1151.
3. J Matern Fetal Neonatal Med. 2016; 29(21): 3467-71.