Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.06.002
Brazilian Journal of Anesthesiology
Clinical Research

Anesthesia technique and postpartum hemorrhage: a prospective cohort study

Anderson Borovac-Pinheiro; Maria José Nascimento Brandão; Juliana Luz Passos Argenton; Thales Daniel Alves Barbosa; Rodolfo Carvalho Pacagnella

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Abstract

Background and objective
During the past few years, an increased number of postpartum hemorrhages have been noticed, even in high-income countries. It has been suggested that this escalation could be associated with increased obstetric interventions. Among such interventions, anesthesia is one of the most prevalent. The present study aimed to investigate the influence of peripartum anesthesia on total blood loss during the 24 hours after delivery.

Methods
We performed a complementary analysis from a prospective cohort study that evaluated postpartum bleeding within 24 hours after birth. The study was performed between February 1st, 2015 and March 31st, 2016 at the Women’s Hospital at the Universidade Estadual de Campinas, Brazil. Postpartum bleeding was measured using a calibrated drape and summing the blood contained in the compresses and pads used for 24 hours. We calculated means, percentages, and standard deviation and performed Mann-Whitney analysis for the relation of anesthesia with Postpartum Hemorrhage (PPH) and logistic regression for drugs used in the anesthesia with PPH, using SAS 9.4 software.

Results
We included 270 women in the study; of these, 168 received anesthesia for delivery and almost 50% of them had spinal and epidural anesthesia. The mean blood loss within 24 hours after delivery did not show differences between those who did and those who did not receive obstetrical anesthesia (579.0 ± 361.6 vs. 556.6 ± 360.6; p = 0.57). Logistic regression showed that anesthesia, the type of anesthesia, and the drug used did not influence the PPH above 500 mL and above 1000 mL within 2 hours (p > 0.05).

Conclusion
Anesthesia did not influence postpartum bleeding after vaginal delivery.

Keywords

Obstetrical anesthesia;  Postpartum hemorrhage;  Obstetric delivery

References

1 N.J. Kassebaum, R.M. Barber, Z.A. Bhutta, et al. Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 Lancet, 388 (2016), pp. 1775-1812

2 M.S. Kramer, C. Berg, H. Abenhaim, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage Am J Obstet Gynecol, 209 (2013) 449.e1-7

3 A. Mehrabadi, JA Hutcheon, L. Lee, et al. Trends in postpartum hemorrhage from 2000 to 2009: a population-based study BMC Pregnancy Childbirth, 12 (2012), p. 108

4 J. Rossen, I. Okland, O.B. Nilsen, et al. Is there an increase of postpartum hemorrhage, and is severe hemorrhage associated with more frequent use of obstetric interventions? Acta Obstet Gynecol Scand, 89 (2010), pp. 1248-1255

5 S. Lisonkova, A. Mehrabadi, V.M. Allen, et al. Atonic Postpartum Hemorrhage: Blood Loss, Risk Factors, and Third Stage Management J Obstet Gynaecol Canada, 38 (2016), pp. 1081-1090.e2

6 E. Biguzzi, F. Franchi, F. Ambrogi, et al. Risk factors for postpartum hemorrhage in a cohort of 6011 Italian women Thromb Res, 129 (2012), pp. e1-7

7 C.-C. Chang, I.-T. Wang, Y.-H. Chen, et al. Anesthetic management as a risk factor for postpartum hemorrhage after cesarean deliveries Am J Obstet Gynecol, 205 (2011), pp. 462.e1-462.e7

8 A. Borovac-Pinheiro, R.C. Pacagnella, J.G. Cecatti, et al. Postpartum hemorrhage: new insights for definition and diagnosis Am J Obstet Gynecol, 219 (2018), pp. 162-168

9 J.H. MacLeod Estimation of blood loss in a small community hospital Can Med Assoc J, 95 (1966), pp. 114-117

10 A Patel, S.S. Goudar, S.E. Geller, et al. Drape estimation vs. visual assessment for estimating postpartum hemorrhage Int J Gynaecol Obstet, 93 (2006), pp. 220-224

11 J.A. Hanley, B.J. McNeil The meaning and use of the area under a receiver operating characteristic (ROC) curve Radiology, 143 (1982), pp. 29-36

12 A.J. Wikkelsø, H.M. Edwards, A. Afshari, et al. Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial Br J Anaesth, 114 (2015), pp. 623-633

13 H.A. Mousa, V. Cording, Z. Alfirevic Risk factors and interventions associated with major primary postpartum hemorrhage unresponsive to first-line conventional therapy Acta Obstet Gynecol Scand, 87 (2008), pp. 652-661

14 A.J. Butwick, B. Ramachandran, P. Hegde, et al. Risk factors for severe postpartum hemorrhage after cesarean delivery Anesth Analg, 125 (2017), pp. 523-532

15 M. Heesen, T. Hofmann, S. Klöhr, et al. Is general anaesthesia for caesarean section associated with postpartum haemorrhage? Systematic review and meta-analysis Acta Anaesthesiol Scand, 57 (2013), pp. 1092-1102

16 O. Tunçalp, J.P. Souza, M. Gülmezoglu New WHO recommendations on prevention and treatment of postpartum hemorrhage Int J Gynaecol Obstet, 123 (2013), pp. 254-256

17 N.L. Sloan, J. Durocher, T. Aldrich, et al. What measured blood loss tells us about postpartum bleeding: a systematic review BJOG, 117 (2010), pp. 788-800

18 W.H. Rath Postpartum hemorrhage-update on problems of definitions and diagnosis Acta Obstet Gynecol Scand, 90 (2011), pp. 421-428

19 S. Ononge, F. Mirembe, J. Wandabwa, et al. Incidence and risk factors for postpartum hemorrhage in Uganda Reprod Health, 13 (2016), p. 38

20 W. Rath, A. Hackethal, M.K. Bohlmann Second-line treatment of postpartum haemorrhage (PPH) Arch Gynecol Obstet, 286 (2012), pp. 549-561

21 M.N. Schorn Measurement of blood loss: review of the literature J Midwifery Womens Health, 55 (2010), pp. 20-27

22 S. Ambardekar, T. Shochet, H. Bracken, et al. Calibrated delivery drape versus indirect gravimetric technique for the measurement of blood loss after delivery: a randomized trial BMC Pregnancy Childbirth, 14 (2014), p. 276
 

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