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Anouilh F, de Moreuil C, Trémouilhac C, Jacquot M, Salnelle G, Bellec V, Touffet N, Cornec C, Muller M, Dupré PF, Bellot C, Morcel K, Joliff DL, Drugmanne G, Gelebart E, Lucier S, Nowak E, Bihan L, Couturaud F, Tromeur C, Moigne EL, Pan-Petesch B. Family history of postpartum hemorrhage is a risk factor for postpartum hemorrhage after vaginal delivery: results from the French prospective multicenter Haemorrhages and Thromboembolic Venous Disease of the Postpartum cohort study. Am J Obstet Gynecol MFM 2023; 5:101062. [PMID: 37343695 DOI: 10.1016/j.ajogmf.2023.101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Postpartum hemorrhage is a major component of perinatal morbidity and mortality that affects young women worldwide and is still often unpredictable. Reducing the incidence of postpartum hemorrhage is a major health issue and identifying women at risk for postpartum hemorrhage is a key element in preventing this complication. OBJECTIVE This study aimed to estimate postpartum hemorrhage prevalence after vaginal delivery and to identify postpartum hemorrhage risk factors. STUDY DESIGN Unselected pregnant women ≥16 years of age admitted to 1 of 6 maternity wards in Brittany (France) for vaginal birth after 15 weeks of gestation were recruited in this prospective, multicenter cohort study between June 1, 2015, and January 31, 2019. Postpartum hemorrhage was defined as blood loss ≥500 mL in the 24 hours following delivery. Independent risk factors for postpartum hemorrhage were determined using logistic regression. Missing data were imputed using the Multivariate Imputation by Chained Equations method. RESULTS Among 16,382 included women, the postpartum hemorrhage prevalence was 5.37%. A first-degree family history of postpartum hemorrhage (adjusted odds ratio, 1.63; 95% confidence interval, 1.24-2.14) and a personal transfusion history (adjusted odds ratio, 1.90; 95% confidence interval, 1.23-2.92) were significantly associated with postpartum hemorrhage. The use of oxytocin during labor was also a risk factor for postpartum hemorrhage (adjusted odds ratio, 1.24; 95% confidence interval, 1.06-1.44). Inversely, smoking during pregnancy and intrauterine growth restriction were associated with a reduced risk for postpartum hemorrhage (adjusted odds ratio, 0.76; 95% confidence interval, 0.63-0.91, and 0.34; 95% confidence interval, 0.13-0.87, respectively). CONCLUSION In addition to classical risk factors, this study identified a family history of postpartum hemorrhage and personal transfusion history as new characteristics associated with postpartum hemorrhage after vaginal delivery. The association of postpartum hemorrhage with a family history of postpartum hemorrhage suggests a hereditary hemorrhagic phenotype and calls for genetic studies. Identifying women at risk for postpartum hemorrhage is a key element of being prepared for this complication.
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Affiliation(s)
- François Anouilh
- Ecole Universitaire de Maïeutique de Brest, UFR Santé - Brest, Brest, France (Mr Anouilh); UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch)
| | - Claire de Moreuil
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne).
| | - Christophe Trémouilhac
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Matthieu Jacquot
- Service de Gynécologie Obstétrique, CHIC de Quimper, Quimper, France (Drs Jacquot, Bellot, and Le Joliff)
| | - Gilles Salnelle
- Service de Gynécologie Obstétrique, CH des Pays de Morlaix, Morlaix, France (Drs Salnelle and Muller)
| | - Violaine Bellec
- Service de Gynécologie Obstétrique, Centre Hospitalier Privé de Brest - Keraudren, Brest, France (Dr Bellec)
| | - Nathalie Touffet
- Service de Gynécologie Obstétrique, CH de Landerneau, Landerneau, France (Dr Touffet)
| | - Caroline Cornec
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Matthieu Muller
- Service de Gynécologie Obstétrique, CH des Pays de Morlaix, Morlaix, France (Drs Salnelle and Muller)
| | - Pierre-François Dupré
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Charles Bellot
- Service de Gynécologie Obstétrique, CHIC de Quimper, Quimper, France (Drs Jacquot, Bellot, and Le Joliff)
| | - Karine Morcel
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Delphine Le Joliff
- Service de Gynécologie Obstétrique, CHIC de Quimper, Quimper, France (Drs Jacquot, Bellot, and Le Joliff)
| | - Guillaume Drugmanne
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Elodie Gelebart
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Sandy Lucier
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Emmanuel Nowak
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Line Bihan
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Francis Couturaud
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne)
| | - Cécile Tromeur
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne)
| | - Emmanuelle Le Moigne
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne)
| | - Brigitte Pan-Petesch
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Centre de Ressources et de Compétence des Maladies Hémorragiques, Centre de Ressources et de Compétence des Maladies Hémorragiques, Hémostase, Service Hématologie, Centre Hospitalier Universitaire Brest, Brest, France (Dr Pan-Petesch)
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de Moreuil C, Anouilh F, Pan-Petesch B. Reply: A need for further investigations on the family risk for postpartum hemorrhage after vaginal delivery. Am J Obstet Gynecol MFM 2023; 5:101089. [PMID: 37433347 DOI: 10.1016/j.ajogmf.2023.101089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Claire de Moreuil
- Department of Internal Medicine, Vascular Medicine and Pneumology, University and Regional Hospital Centre Brest, Brest, France; UMR 1304, GETBO, Université de Bretagne Occidentale, Brest, France
| | - François Anouilh
- Ecole Universitaire de Maïeutique de Brest, UFR Santé, Brest, France; Gynecology and Obstetric department, Brest University Hospital, Brest, France; UMR 1304, GETBO, Université de Bretagne Occidentale, Brest, France
| | - Brigitte Pan-Petesch
- Service d'Hématologie, Centre de Ressources et de Compétence des Maladies Hémorragiques, University and Regional Hospital Centre Brest, Brest France; UMR 1304, GETBO, Université de Bretagne Occidentale, Brest, France.
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de Moreuil C, Pan-Petesch B, Trémouilhac C, Dupré PF, Merviel P, Anouilh F, Bellot C, Müller M, Drugmanne G, Nowak E, Coadic J, Bihan L, Gourhant L, Lemarié C, Robin S, Couturaud F, Moigne EL. Clinical risk factors for vasculo-placental disorders: results from a prospective case-control study nested in HEMOTHEPP French cohort study. J Gynecol Obstet Hum Reprod 2023; 52:102511. [PMID: 36417979 DOI: 10.1016/j.jogoh.2022.102511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Determine clinical risk factors for vasculo-placental disorders in singleton pregnancies. DESIGN Prospective case-control study nested in HEMOTHEPP French cohort. SETTING Women delivered between June, 2015 and January, 2019 in any maternity ward of Finistère. POPULATION Cases were women with vasculo-placental disorders (pre-eclampsia, intrauterine growth restriction (IUGR), placental abruption or stillbirth). Controls were women matched for age at delivery and parity. METHODS Clinical data were collected by obstetricians or midwives during antenatal care visits and delivery, and recorded by trained research assistants. MAIN OUTCOME MEASURES Occurrence of a vasculo-placental disorder. RESULTS 505 women with vasculo-placental disorder (299 pre-eclampsia, 253 IUGR, 44 placental abruptions, 11 stillbirths) and 1515 matched controls were selected out of 20,075 participants. In multivariable analysis, four clinical parameters were associated with pre-eclampsia: obesity (Odd ratio (OR) = 3.11, 95%CI 2.11-4.58), French overseas origin (OR = 4.41, 95%CI 1.87-10.42), previous vasculo-placental disorder (OR = 5.14, 95%CI 2.72-9.70), aspirin during pregnancy (OR = 10.10, 95%CI 1.99-51.08). Three clinical parameters were associated with IUGR: auto-immune/inflammatory disorder (OR = 3.75, 95%CI 1.83-7.68), previous vasculo-placental disorder (OR = 3.63, 95%CI 2.06-6.41), smoking during pregnancy (OR = 2.66, 95%CI 1.91- 3.71). A previous venous thromboembolism (VTE) was associated with IUGR in univariable but not in multivariable analysis (OR = 3.72, 95%CI 0.82-17.00, p = 0.09). CONCLUSIONS Clinical risk factors differ between IUGR and pre-eclampsia, the later, but not the former, being associated with cardiovascular risk factors.
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Affiliation(s)
- Claire de Moreuil
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Département de médecine interne, médecine vasculaire et pneumologie, CHU Brest - Brest (France), Boulevard Tanguy Prigent, F-29609 Brest Cedex, France.
| | - Brigitte Pan-Petesch
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Centre de traitement de l'hémophilie, Hématologie, CHU Brest - Brest (France), France
| | - Christophe Trémouilhac
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Service de Gynécologie Obstétrique, CHU Brest - Brest (France), France
| | - Pierre-François Dupré
- Service de Gynécologie Obstétrique, CHU Brest - Brest (France), France; INSERM 1078, équipe GTCA, France
| | - Philippe Merviel
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Service de Gynécologie Obstétrique, CHU Brest - Brest (France), France
| | - François Anouilh
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Ecole de Sage-femmes, UFR Santé - Brest (France), France
| | - Charles Bellot
- Service de Gynécologie Obstétrique, CHIC de Quimper - Quimper (France), France
| | - Matthieu Müller
- Service de Gynécologie Obstétrique, CH des Pays de Morlaix - Morlaix (France), France
| | | | | | | | - Line Bihan
- CIC1412, INSERM - Brest (France), France
| | - Lénaick Gourhant
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France
| | - Catherine Lemarié
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France
| | - Sara Robin
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Département de médecine interne, médecine vasculaire et pneumologie, CHU Brest - Brest (France), Boulevard Tanguy Prigent, F-29609 Brest Cedex, France
| | - Francis Couturaud
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Département de médecine interne, médecine vasculaire et pneumologie, CHU Brest - Brest (France), Boulevard Tanguy Prigent, F-29609 Brest Cedex, France
| | - Emmanuelle Le Moigne
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), France; Département de médecine interne, médecine vasculaire et pneumologie, CHU Brest - Brest (France), Boulevard Tanguy Prigent, F-29609 Brest Cedex, France
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Bihan L, Nowak E, Anouilh F, Tremouilhac C, Merviel P, Tromeur C, Robin S, Drugmanne G, Le Roux L, Couturaud F, Le Moigne E, Abgrall JF, Pan-Petesch B, de Moreuil C. Development and Validation of a Predictive Tool for Postpartum Hemorrhage after Vaginal Delivery: A Prospective Cohort Study. Biology (Basel) 2022; 12:biology12010054. [PMID: 36671746 PMCID: PMC9855728 DOI: 10.3390/biology12010054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022]
Abstract
Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity worldwide. This study aimed to develop and validate a predictive model for PPH after vaginal deliveries, based on routinely available clinical and biological data. The derivation monocentric cohort included pregnant women with vaginal delivery at Brest University Hospital (France) between April 2013 and May 2015. Immediate PPH was defined as a blood loss of ≥500 mL in the first 24 h after delivery and measured with a graduated collector bag. A logistic model, using a combination of multiple imputation and variable selection with bootstrap, was used to construct a predictive model and a score for PPH. An external validation was performed on a prospective cohort of women who delivered between 2015 and 2019 at Brest University Hospital. Among 2742 deliveries, PPH occurred in 141 (5.1%) women. Eight factors were independently associated with PPH: pre-eclampsia (aOR 6.25, 95% CI 2.35−16.65), antepartum bleeding (aOR 2.36, 95% CI 1.43−3.91), multiple pregnancy (aOR 3.24, 95% CI 1.52−6.92), labor duration ≥ 8 h (aOR 1.81, 95% CI 1.20−2.73), macrosomia (aOR 2.33, 95% CI 1.36−4.00), episiotomy (aOR 2.02, 95% CI 1.40−2.93), platelet count < 150 Giga/L (aOR 2.59, 95% CI 1.47−4.55) and aPTT ratio ≥ 1.1 (aOR 2.01, 95% CI 1.25−3.23). The derived predictive score, ranging from 0 to 10 (woman at risk if score ≥ 1), demonstrated a good discriminant power (AUROC 0.69; 95% CI 0.65−0.74) and calibration. The external validation cohort was composed of 3061 vaginal deliveries. The predictive score on this independent cohort showed an acceptable ability to discriminate (AUROC 0.66; 95% CI 0.62−0.70). We derived and validated a robust predictive model identifying women at risk for PPH using in-depth statistical methodology. This score has the potential to improve the care of pregnant women and to take preventive actions on them.
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Affiliation(s)
| | | | - François Anouilh
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Ecole de Sage-Femmes, UFR Santé, 29200 Brest, France
| | - Christophe Tremouilhac
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Service de Gynécologie Obstétrique, CHU Brest, 29200 Brest, France
| | - Philippe Merviel
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Service de Gynécologie Obstétrique, CHU Brest, 29200 Brest, France
| | - Cécile Tromeur
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Département de Médecine Vasculaire, Médecine Interne et Pneumologie, CHU Brest, 29200 Brest, France
| | - Sara Robin
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Département de Médecine Vasculaire, Médecine Interne et Pneumologie, CHU Brest, 29200 Brest, France
| | | | - Liana Le Roux
- CIC1412, INSERM, 29200 Brest, France
- CIC-RB Ressources Biologiques (UF 0827), CHU Brest, 29200 Brest, France
| | - Francis Couturaud
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Département de Médecine Vasculaire, Médecine Interne et Pneumologie, CHU Brest, 29200 Brest, France
| | - Emmanuelle Le Moigne
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Département de Médecine Vasculaire, Médecine Interne et Pneumologie, CHU Brest, 29200 Brest, France
| | | | - Brigitte Pan-Petesch
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Centre de Traitement de L’hémophilie, Hématologie, CHU Brest, 29200 Brest, France
| | - Claire de Moreuil
- UMR1304, INSERM, GETBO, Université de Bretagne Occidentale, CHRU de Brest, 29200 Brest, France
- Département de Médecine Vasculaire, Médecine Interne et Pneumologie, CHU Brest, 29200 Brest, France
- Correspondence:
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de Moreuil C, Tromeur C, Daoudal A, Trémouilhac C, Merviel P, Anouilh F, Le Mao R, Hoffman C, Guegan M, Poulhazan E, Gourhant L, Lemarié C, Couturaud F, Le Moigne E. Risk factors for recurrence during a pregnancy following a first venous thromboembolism: A French observational study. J Thromb Haemost 2022; 20:909-918. [PMID: 35020974 DOI: 10.1111/jth.15639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women with a previous venous thromboembolism (VTE) are at risk of recurrence during pregnancy. OBJECTIVES We aimed to assess the incidence rate of recurrent VTE during pregnancy, according to the period of pregnancy, and the clinical parameters associated with recurrence, in a prospective cohort of women of childbearing age after a first VTE. PATIENTS/METHODS A total of 189 women aged 15-49 years with a first documented VTE were followed until a subsequent pregnancy of at least 20 weeks' gestation between 2000 and 2020. VTE recurrences during pregnancy were recorded, as were potential clinical risk factors for recurrence. RESULTS Recurrent VTE occurred in six women during antepartum: five during the first trimester (incidence rate 106.4 per 1000 women-years) (95% confidence interval [CI] 46.3-226.0); none during the second trimester; and one during the third trimester (incidence rate 27.0 per 1000 women-years [95% CI 4.8-138.2]). During postpartum, recurrences occurred in 11 women (incidence rate 212.8 per 1000 women-years [95% CI 119.9-349.1]). These 17 recurrent VTEs presented as pulmonary embolism ± deep vein thrombosis (DVT) in five patients and isolated DVT in 12. Failure of thromboprophylaxis occurred in two cases (33.3%) antepartum and in 10 cases (90.9%) postpartum. In multivariable analysis, only obesity (defined on prepregnancy body mass index) was associated with recurrent VTE (odds ratio 3.34 [95% CI 1.11-10.05, p = .03]). CONCLUSIONS This study confirms a high risk of recurrent VTE postpartum, despite thromboprophylaxis, in women with a previous VTE. Only obesity was associated with VTE recurrence during pregnancy, suggesting that low-dose anticoagulation might not be appropriate in obese pregnant women.
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Affiliation(s)
- Claire de Moreuil
- EA3878, GETBO, University Brest (France), Brest, France
- Département de Médecine Interne, Médecine Vasculaire et Pneumologie, CHU Brest - Brest (France), Brest, France
| | - Cécile Tromeur
- EA3878, GETBO, University Brest (France), Brest, France
- Département de Médecine Interne, Médecine Vasculaire et Pneumologie, CHU Brest - Brest (France), Brest, France
| | | | - Christophe Trémouilhac
- EA3878, GETBO, University Brest (France), Brest, France
- Service de Gynécologie Obstétrique, CHU Brest - Brest (France), Brest, France
| | - Philippe Merviel
- EA3878, GETBO, University Brest (France), Brest, France
- Service de Gynécologie Obstétrique, CHU Brest - Brest (France), Brest, France
| | - François Anouilh
- EA3878, GETBO, University Brest (France), Brest, France
- Ecole de Sage-femmes, UFR Santé - Brest (France), Brest, France
| | - Raphaël Le Mao
- EA3878, GETBO, University Brest (France), Brest, France
- Département de Médecine Interne, Médecine Vasculaire et Pneumologie, CHU Brest - Brest (France), Brest, France
| | - Clément Hoffman
- EA3878, GETBO, University Brest (France), Brest, France
- Département de Médecine Interne, Médecine Vasculaire et Pneumologie, CHU Brest - Brest (France), Brest, France
| | - Marie Guegan
- EA3878, GETBO, University Brest (France), Brest, France
| | | | | | | | - Francis Couturaud
- EA3878, GETBO, University Brest (France), Brest, France
- Département de Médecine Interne, Médecine Vasculaire et Pneumologie, CHU Brest - Brest (France), Brest, France
| | - Emmanuelle Le Moigne
- EA3878, GETBO, University Brest (France), Brest, France
- Département de Médecine Interne, Médecine Vasculaire et Pneumologie, CHU Brest - Brest (France), Brest, France
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Salomon C, de Moreuil C, Hannigsberg J, Trémouilhac C, Drugmanne G, Gatineau F, Nowak E, Anouilh F, Briend D, Moigne EL, Merviel P, Abgrall JF, Lacut K, Petesch BP. Haematological parameters associated with postpartum haemorrhage after vaginal delivery: Results from a French cohort study. J Gynecol Obstet Hum Reprod 2021; 50:102168. [PMID: 34033967 DOI: 10.1016/j.jogoh.2021.102168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/11/2021] [Accepted: 05/19/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Immediate postpartum haemorrhage (PPH) is a major, feared and often unpredictable issue. Besides many clinical risk factors, some biological parameters could also be predictive of PPH. OBJECTIVE To study simple and easily accessible haematological parameters as potential risk factors for PPH after vaginal delivery. METHODS All women who had a vaginal delivery between April 1, 2013 and May 29, 2015 in the maternity ward of Brest University Hospital (France) were included, after oral informed consent obtained. Clinical data were collected by obstetricians or midwives during antenatal care visits, labour and delivery, and recorded by trained research assistants. Haematological variables, including immature platelet fraction, were measured from a blood sample systematically collected at the entrance in the delivery room. PPH, measured with a graduated collector bag, was defined as blood loss of at least 500 ml. RESULTS 2742 women were included. PPH occurred in 141 (5%) women. Seven clinical factors were independently associated with PPH: pre-eclampsia (OR 5.85, 95%CI 2.02, 16.90), multiple pregnancy (OR 3.28, 95%CI 1.21, 8.91), assisted reproduction (OR 2.75, 95%CI 1.45, 5.20), antepartum bleeding (OR 2.15, 95%CI 1.24,3.73), post-term delivery (OR 1.93, 95%CI 1.17, 3.17), obesity (OR 2.95, 95%CI 1.76, 4.93) and episiotomy (OR 2.51, 95%CI 1.63, 3.74). Three haematological factors were additionally identified as independent risk factors for PPH: platelets < 150 Giga/L (OR 2.98, 95%CI 1.63, 5.46), fibrinogen < 4.5 g/l (OR 1.86, 95%CI 1.21, 2.87) and APTT ratio ≥ 1.1 (OR 2.16, 95%CI 1.31, 3.57). Immature platelet fraction was not associated with PPH. CONCLUSION Besides classical clinical risk factors, this study identifies simple haematological parameters as risk factors for PPH.
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Affiliation(s)
- C Salomon
- EA3878, Université de Bretagne Occidentale - Brest,France
| | - C de Moreuil
- EA3878, Université de Bretagne Occidentale - Brest,France; Département de médecine interne, médecine vasculaire et pneumologie, CHU Brest - Brest, France.
| | - J Hannigsberg
- EA3878, Université de Bretagne Occidentale - Brest,France; Service de Gynécologie Obstétrique, CHU Brest - Brest, France
| | - C Trémouilhac
- EA3878, Université de Bretagne Occidentale - Brest,France; Service de Gynécologie Obstétrique, CHU Brest - Brest, France
| | | | | | - E Nowak
- CIC1412, INSERM - Brest, France
| | - F Anouilh
- Ecole de Sage-femmes, UFR Santé - Brest, France
| | - D Briend
- Service de Gynécologie Obstétrique, CHU Brest - Brest, France
| | - E Le Moigne
- EA3878, Université de Bretagne Occidentale - Brest,France; Département de médecine interne, médecine vasculaire et pneumologie, CHU Brest - Brest, France
| | - P Merviel
- EA3878, Université de Bretagne Occidentale - Brest,France; Service de Gynécologie Obstétrique, CHU Brest - Brest, France
| | - J F Abgrall
- Centre de traitement de l'hémophilie, Hématologie, CHU Brest - Brest,France
| | - K Lacut
- EA3878, Université de Bretagne Occidentale - Brest,France; Département de médecine interne, médecine vasculaire et pneumologie, CHU Brest - Brest, France
| | - B Pan Petesch
- EA3878, Université de Bretagne Occidentale - Brest,France; Centre de traitement de l'hémophilie, Hématologie, CHU Brest - Brest,France
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Renesme L, Garlantézec R, Anouilh F, Bertschy F, Carpentier M, Sizun J. Accidental out-of-hospital deliveries: a case-control study. Acta Paediatr 2013; 102:e174-7. [PMID: 23301804 DOI: 10.1111/apa.12156] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 12/08/2012] [Accepted: 01/04/2013] [Indexed: 11/29/2022]
Abstract
AIM To determine risk factors for accidental out-of-hospital deliveries (OHDs), which represent 0.5% of live births in France and are associated with poor neonatal outcomes. METHODS This retrospective case-control study assessed accidental OHDs that occurred in the Finistère District (Brittany, France) between January 2007 and December 2009. For each OHD case, two controls were randomly selected. Outcome measures included maternal demographics, obstetric characteristics and neonatal outcomes. RESULTS During the study period, accidental OHDs accounted for 0.42% of all births; 76 accidental OHDs were included in the analysis. Multivariate analysis found four independent risk factors for accidental OHD: multiparity [OR: 8.84 (3.22-24.29)], unemployment [OR: 4.99 (1.85-13.47)], lack of or poor antenatal care [OR: 9.00 (2.41-33.72)] and a travel time >45 min from home to the delivery unit [OR: 6.18 (1.33-28.65) versus < 15 min]. Significantly more newborns from the OHD group required admission to the neonatal unit (p = 0.04), but accidental OHD was not significantly associated with prematurity or low birth weight. CONCLUSION Four risk factors for accidental OHD were identified. Setting up an anonymous registry of OHD cases could improve our knowledge and screening of women at risk.
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Affiliation(s)
- L Renesme
- Pôle de la Femme de la Mère et de l'Enfant; CHU Brest; Brest France
| | - R Garlantézec
- Service de Santé Publique; CHU de Brest; Brest France
| | - F Anouilh
- Réseau de Périnatalité de Bretagne Occidentale (RPBO); Brest France
| | - F Bertschy
- Réseau de Périnatalité de Bretagne Occidentale (RPBO); Brest France
| | - M Carpentier
- Service de Santé Publique; CHU de Brest; Brest France
| | - J Sizun
- Pôle de la Femme de la Mère et de l'Enfant; CHU Brest; Brest France
- Faculté de Médecine et des Sciences de la Santé; Université de Brest; Brest France
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