Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India

<p><strong>Objective:&nbsp;</strong>To investigate whether induction/augmentation of labor in pregnant women with anemia increases the risk of postpartum hemorrhage (PPH) and whether this risk varied by indications for labor induction/augmentation and by anemia severity in preg...

Mô tả đầy đủ

Chi tiết về thư mục
Những tác giả chính: Cheng, TS, Zahir, F, Solomi V, C, Verma, A, Rao, S, Choudhury, SS, Deka, G, Mahanta, P, Kakoty, S, Medhi, R, Chhabra, S, Rani, A, Bora, A, Roy, I, Minz, B, Bharti, OK, Deka, R, Opondo, C, Churchill, D, Knight, M, Kurinczuk, JJ, Nair, M
Định dạng: Journal article
Ngôn ngữ:English
Được phát hành: Wiley 2024
_version_ 1826315328329613312
author Cheng, TS
Zahir, F
Solomi V, C
Verma, A
Rao, S
Choudhury, SS
Deka, G
Mahanta, P
Kakoty, S
Medhi, R
Chhabra, S
Rani, A
Bora, A
Roy, I
Minz, B
Bharti, OK
Deka, R
Opondo, C
Churchill, D
Knight, M
Kurinczuk, JJ
Nair, M
author_facet Cheng, TS
Zahir, F
Solomi V, C
Verma, A
Rao, S
Choudhury, SS
Deka, G
Mahanta, P
Kakoty, S
Medhi, R
Chhabra, S
Rani, A
Bora, A
Roy, I
Minz, B
Bharti, OK
Deka, R
Opondo, C
Churchill, D
Knight, M
Kurinczuk, JJ
Nair, M
author_sort Cheng, TS
collection OXFORD
description <p><strong>Objective:&nbsp;</strong>To investigate whether induction/augmentation of labor in pregnant women with anemia increases the risk of postpartum hemorrhage (PPH) and whether this risk varied by indications for labor induction/augmentation and by anemia severity in pregnancy.</p> <p><strong>Methods:&nbsp;</strong>In a prospective cohort study of 9420 pregnant women from 13 hospitals across India, we measured hemoglobin concentrations at recruitment (&ge;28&thinsp;weeks of gestation) and blood loss after childbirth during follow-up and collected clinical information about PPH. Clinical obstetric and childbirth information at both visits were extracted from medical records. Anemia severity in the third trimester was categorized using hemoglobin concentrations (no/mild anemia: hemoglobin &ge;10&thinsp;g/dL; moderate: hemoglobin 7 to 9.9&thinsp;g/dL; severe: hemoglobin &lt;7&thinsp;g/dL), while PPH was defined based on blood loss volume (vaginal births: &ge;500&thinsp;mL or cesarean sections: &ge;1000&thinsp;mL) and clinical diagnosis. Indications for labor induction/augmentation were classified as clinically indicated and elective as per guidelines. We performed multivariable modified Poisson regression analyses to investigate the associations of anemia severity and indications for labor induction/augmentation, including their interaction, with PPH, adjusted for potential confounders.</p> <p><strong>Results:&nbsp;</strong>PPH was associated with anemia but not with indications for labor induction/augmentation. However, there was a significant interaction between the two factors in relation to PPH (<em>P</em>&thinsp;=&thinsp;0.003). Among pregnant women with severe anemia, a higher risk of PPH was associated with elective (adjusted risk ratio, 3.44 [95% confidence interval, 1.29&ndash;9.18]) but not with clinically indicated (adjusted risk ratio, 1.22 [95% confidence interval, 0.42&ndash;3.55]) labor induction/augmentation. No associations were observed among pregnant women with no/mild and moderate anemia.</p> <p><strong>Conclusion:&nbsp;</strong>The risk of PPH is higher in women who have moderate&ndash;severe anemia in late pregnancy. Induction/augmentation of labor is generally safe for women with anemia, but it can increase the risk of PPH in women with severe anemia if performed electively.</p>
first_indexed 2024-12-09T03:22:02Z
format Journal article
id oxford-uuid:4930403c-6e06-4ae2-810d-876fdb81488c
institution University of Oxford
language English
last_indexed 2024-12-09T03:22:02Z
publishDate 2024
publisher Wiley
record_format dspace
spelling oxford-uuid:4930403c-6e06-4ae2-810d-876fdb81488c2024-11-21T07:42:47ZDoes induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in IndiaJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:4930403c-6e06-4ae2-810d-876fdb81488cEnglishSymplectic ElementsWiley2024Cheng, TSZahir, FSolomi V, CVerma, ARao, SChoudhury, SSDeka, GMahanta, PKakoty, SMedhi, RChhabra, SRani, ABora, ARoy, IMinz, BBharti, OKDeka, ROpondo, CChurchill, DKnight, MKurinczuk, JJNair, M<p><strong>Objective:&nbsp;</strong>To investigate whether induction/augmentation of labor in pregnant women with anemia increases the risk of postpartum hemorrhage (PPH) and whether this risk varied by indications for labor induction/augmentation and by anemia severity in pregnancy.</p> <p><strong>Methods:&nbsp;</strong>In a prospective cohort study of 9420 pregnant women from 13 hospitals across India, we measured hemoglobin concentrations at recruitment (&ge;28&thinsp;weeks of gestation) and blood loss after childbirth during follow-up and collected clinical information about PPH. Clinical obstetric and childbirth information at both visits were extracted from medical records. Anemia severity in the third trimester was categorized using hemoglobin concentrations (no/mild anemia: hemoglobin &ge;10&thinsp;g/dL; moderate: hemoglobin 7 to 9.9&thinsp;g/dL; severe: hemoglobin &lt;7&thinsp;g/dL), while PPH was defined based on blood loss volume (vaginal births: &ge;500&thinsp;mL or cesarean sections: &ge;1000&thinsp;mL) and clinical diagnosis. Indications for labor induction/augmentation were classified as clinically indicated and elective as per guidelines. We performed multivariable modified Poisson regression analyses to investigate the associations of anemia severity and indications for labor induction/augmentation, including their interaction, with PPH, adjusted for potential confounders.</p> <p><strong>Results:&nbsp;</strong>PPH was associated with anemia but not with indications for labor induction/augmentation. However, there was a significant interaction between the two factors in relation to PPH (<em>P</em>&thinsp;=&thinsp;0.003). Among pregnant women with severe anemia, a higher risk of PPH was associated with elective (adjusted risk ratio, 3.44 [95% confidence interval, 1.29&ndash;9.18]) but not with clinically indicated (adjusted risk ratio, 1.22 [95% confidence interval, 0.42&ndash;3.55]) labor induction/augmentation. No associations were observed among pregnant women with no/mild and moderate anemia.</p> <p><strong>Conclusion:&nbsp;</strong>The risk of PPH is higher in women who have moderate&ndash;severe anemia in late pregnancy. Induction/augmentation of labor is generally safe for women with anemia, but it can increase the risk of PPH in women with severe anemia if performed electively.</p>
spellingShingle Cheng, TS
Zahir, F
Solomi V, C
Verma, A
Rao, S
Choudhury, SS
Deka, G
Mahanta, P
Kakoty, S
Medhi, R
Chhabra, S
Rani, A
Bora, A
Roy, I
Minz, B
Bharti, OK
Deka, R
Opondo, C
Churchill, D
Knight, M
Kurinczuk, JJ
Nair, M
Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India
title Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India
title_full Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India
title_fullStr Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India
title_full_unstemmed Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India
title_short Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India
title_sort does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia a multicenter prospective cohort study in india
work_keys_str_mv AT chengts doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT zahirf doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT solomivc doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT vermaa doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT raos doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT choudhuryss doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT dekag doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT mahantap doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT kakotys doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT medhir doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT chhabras doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT rania doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT boraa doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT royi doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT minzb doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT bhartiok doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT dekar doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT opondoc doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT churchilld doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT knightm doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT kurinczukjj doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia
AT nairm doesinductionoraugmentationoflaborincreasetheriskofpostpartumhemorrhageinpregnantwomenwithanemiaamulticenterprospectivecohortstudyinindia