Main Article Content
anemia, postpartum hemorrhage, vaginal birth, perinatal
Over more than half a million women die due to complications of pregnancy and childbirth each year. In the developing countries the risk of dying in childbirth is 175 times that of developed countries.
Postpartum hemorrhage, is the leading cause of maternal death in developing countries characterized by bleeding (>500 mL) after birth of the baby.
Aim of the study: To evaluate whether maternal anemia contributes to greater blood loss at childbirth and 24 hours postpartum.
Patients and methods: This study is a cross sectional descriptive study, the target 233 patients will be pregnant ladies in labour seen in labour ward in slemani maternity teaching hospital, throughout the period of January first 2017 to August first 2017, evaluated the state of anemia in her third trimester, the hemoglobin level was measured for all the studied women, then they were divided in to groups according to their HB level.
Results: The median age of studied women was 28.5years, and the median gestational age duration was 38.8 weeks, 44.6 percent were hemoglobin level was less than 11 gram / dl, 20.6 percent of these patients developed post partum hemorrhage. 6.4 percent need blood transfusions, 28.9 percent need medical treatment. Commonest causes of post partum hemorrhage among these patients were inertia, genital injury respectively.
Conclusions: The finding of this study support the association between anemia at delivery and the potential risk of PPH which remains currently debated.
ALLEN, L. H. 2000. Anemia and iron deficiency: effects on pregnancy outcome–. The American journal of clinical nutrition, 71, 1280S-1284S.
ARULKUMARAN, S., CHANDRAHARAN, E., MAHMOOD, T., LOUCA, O. & MANNION, C. 2008. Maternity dashboard–clinical performance and governance scorecard. Good Practice, 1-8.
BAIS, J. M., ESKES, M., PEL, M., BONSEL, G. J. & BLEKER, O. P. 2004. Postpartum haemorrhage in nulliparous women: incidence and risk factors in low and high risk women: a Dutch population-based cohort study on standard (≥ 500 ml) and severe (≥ 1000 ml) postpartum haemorrhage. European Journal of Obstetrics & Gynecology and Reproductive Biology, 115, 166-172.
BERGSTRÖM, S. 2003. Infection-related morbidities in the mother, fetus and neonate. The Journal of nutrition, 133, 1656S-1660S.
CHRISTIAN, P. 2008. Nutrition and maternal survival in developing countries. Handbook of Nutrition and Pregnancy. Springer.
CLARK, P., THOMSON, A. J. & GREER, I. A. 2012. Haematological problems in pregnancy. Dewhurst's Textbook of Obstetrics & Gynaecology: Wiley-Blackwell, 151-172.
FRASS, K. A. 2015. Postpartum hemorrhage is related to the hemoglobin levels at labor: Observational study. Alexandria Journal of Medicine, 51, 333–337.
GEELHOED, D., AGADZI, F., VISSER, L., ABLORDEPPEY, E., ASARE, K., O'ROURKE, P., SCHAGEN VAN LEEUWEN, J. & VAN ROOSMALEN, J. 2006. Maternal and fetal outcome after severe anemia in pregnancy in rural Ghana. Acta obstetricia et gynecologica Scandinavica, 85, 49-55.
HARAM, K., NILSEN, S. T. & ULVIK, R. J. 2001. Iron supplementation in pregnancy-evidence and controversies. Acta Obstetricia et Gynecologica Scandinavica, 80, 683-688.
HINDMARSH, P., GEARY, M., RODECK, C. & JACKSON, M. 2000. Effect of early maternal iron stores on placental weight and structure. The Lancet, 356, 719-723.
KALAIVANI, K. 2009. Prevalence & consequences of anaemia in pregnancy. Indian J Med Res, 130, 627-33.
KHAN, G. Q., JOHN, I., WANI, S., DOHERTY, T. & SIBAI, B. M. 1997. Controlled cord traction versus minimal intervention techniques in delivery of the placenta: a randomized controlled trial. American Journal of Obstetrics and Gynecology, 177, 770-774.
MILMAN, N., BYG, K. E. & AGGER, A. O. 2000. Hemoglobin and erythrocyte indices during normal pregnancy and postpartum in 206 women with and without iron supplementation. Acta Obstetricia et Gynecologica Scandinavica: ORIGINAL ARTICLE, 79, 89-98.
OHKUCHI, A., ONAGAWA, T., USUI, R., KOIKE, T., HIRATSUKA, M., IZUMI, A., OHKUSA, T., MATSUBARA, S., SATO, I. & SUZUKI, M. 2003. Effect of maternal age on blood loss during parturition: a retrospective multivariate analysis of 10,053 cases. Journal of perinatal medicine, 31, 209-215.
ORGANIZATION, W. H. 2007. Micronutrient deficiencies. Battling iron deficiency anemia [Online] Nutrition Program. http://www. who. int/nut/ida. htm.
OYELESE, Y. & ANANTH, C. V. 2010. Postpartum hemorrhage: epidemiology, risk factors, and causes. Clinical obstetrics and gynecology, 53, 147-156.
RAMANATHAN, G. & ARULKUMARAN, S. 2006. Postpartum hemorrhage. Journal of Obstetrics and Gynaecology Canada, 28, 967-973.
RUSH, D. 2000. Nutrition and maternal mortality in the developing world–. The American journal of clinical nutrition, 72, 212S-240S.
SANGHVI, T. G., HARVEY, P. W. & WAINWRIGHT, E. 2010. Maternal iron–folic acid supplementation programs: evidence of impact and implementation. Food and Nutrition Bulletin, 31, S100-S107.
WATERSTONE, M., MURPHY, J. D., BEWLEY, S. & WOLFE, C. 2001. Incidence and predictors of severe obstetric morbidity: case-control studyCommentary: Obstetric morbidity data and the need to evaluate thromboembolic disease. Bmj, 322, 1089-1094.
XIONG, Q., ZHANG, G. & CHEN, H. 1994. Analysis of risk factors of postpartum hemorrhage in rural women. Zhonghua fu chan ke za zhi, 29, 582-5, 635.