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Published in: BMC Pregnancy and Childbirth 1/2019

Open Access 01-12-2019 | Sectio Ceasarea | Research article

Estimated blood loss in pregnant women with cardiac disease compared with low risk women: a restrospective cohort study

Authors: Hsu Phern Chong, James Hodson, Tara J. Selman, Lucy E. Hudsmith, Peter J. Thompson, Rachel Katherine Morris, Sara Thorne

Published in: BMC Pregnancy and Childbirth | Issue 1/2019

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Abstract

Background

Women with cardiac disease are thought to be at increased risk of post-partum haemorrhage. We sought to assess the estimated blood loss (EBL) in our cohort of women with and without cardiac disease (CD) in a quaternary hospital in the UK. Our population consisted of both congenital and acquired CD; and low risk women who delivered in our unit between 01/01/2012–30/09/2016.

Methods

Data were collected using computerised hospital records. CD was classified according to the modified WHO classification (mWHO). The primary outcome measure was estimated blood loss (mL).

Results

A total of 5413 women with a singleton fetus in the cephalic presentation delivered during the study period (159 women with CD and 5254 controls). In the CD group, active management of the third stage of labour was consistent with that used in low risk women in 98% (152/155) of cases. Multivariable analyses demonstrated no significant difference in EBL between women with CD vs controls. The adjusted average blood losses were 247.2 ml, 241.8 ml and 295.9 ml in the control group, mWHO 1–2 and 3–4, respectively (p = 0.165).

Conclusions

Women with CD have comparable EBL to low risk women when management of the active third stage of labour is the same.
Literature
1.
go back to reference RCOG. Good practice guide no. 13. In: Cardiac Disease and Pregnancy. London: Royal College of Obstetricians & Gynaecologists; 2011. RCOG. Good practice guide no. 13. In: Cardiac Disease and Pregnancy. London: Royal College of Obstetricians & Gynaecologists; 2011.
2.
go back to reference Cauldwell M, Steer PJ, Swan L, Uebing A, Gatzoulis MA, Johnson MR. The management of the third stage of labour in women with heart disease. Heart. 2017;103(12):945–51.CrossRef Cauldwell M, Steer PJ, Swan L, Uebing A, Gatzoulis MA, Johnson MR. The management of the third stage of labour in women with heart disease. Heart. 2017;103(12):945–51.CrossRef
3.
go back to reference Thomas JS, Koh SH, Cooper GM. Haemodynamic effects of oxytocin given as i.v. bolus or infusion on women undergoing caesarean section. Br J Anaesth. 2007;98(1):116–9.CrossRef Thomas JS, Koh SH, Cooper GM. Haemodynamic effects of oxytocin given as i.v. bolus or infusion on women undergoing caesarean section. Br J Anaesth. 2007;98(1):116–9.CrossRef
4.
go back to reference Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM, Gibbs JS, Gohlke-Baerwolf C, Gorenek B, Iung B, et al. European Society of Cardiology guidelines on the management of cardiovascular diseases during pregnancy: the task force on the Management of Cardiovascular Diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(24):3147–97.CrossRef Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM, Gibbs JS, Gohlke-Baerwolf C, Gorenek B, Iung B, et al. European Society of Cardiology guidelines on the management of cardiovascular diseases during pregnancy: the task force on the Management of Cardiovascular Diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(24):3147–97.CrossRef
5.
go back to reference National Institute for Health and Clinical Excellence. In: Welsh A, editor. CG190: intrapartum care: care of healthy women and their babies. London: National Institute for Health and Clinical Excellence; 2014. National Institute for Health and Clinical Excellence. In: Welsh A, editor. CG190: intrapartum care: care of healthy women and their babies. London: National Institute for Health and Clinical Excellence; 2014.
6.
go back to reference Cauldwell M, Von Klemperer K, Uebing A, Swan L, Steer PJ, Gatzoulis M, Johnson MR. Why is post-partum haemorrhage more common in women with congenital heart disease? Int J Cardiol. 2016;218:285–90.CrossRef Cauldwell M, Von Klemperer K, Uebing A, Swan L, Steer PJ, Gatzoulis M, Johnson MR. Why is post-partum haemorrhage more common in women with congenital heart disease? Int J Cardiol. 2016;218:285–90.CrossRef
7.
go back to reference Mavrides EAS, Chandraharan E, Collins P, Green L, Hunt BJ, Riris S, Thomson AJ. Prevention and management of postpartum haemorrhage. BJOG. 2016;124:e106–49. Mavrides EAS, Chandraharan E, Collins P, Green L, Hunt BJ, Riris S, Thomson AJ. Prevention and management of postpartum haemorrhage. BJOG. 2016;124:e106–49.
8.
go back to reference Hancock A, Weeks AD, Lavender DT. Is accurate and reliable blood loss estimation the ‘crucial step’ in early detection of postpartum haemorrhage: an integrative review of the literature. BMC Pregnancy Childbirth. 2015;15:230.CrossRef Hancock A, Weeks AD, Lavender DT. Is accurate and reliable blood loss estimation the ‘crucial step’ in early detection of postpartum haemorrhage: an integrative review of the literature. BMC Pregnancy Childbirth. 2015;15:230.CrossRef
9.
go back to reference Koutrolou-Sotiropoulou P, Parikh PB, Miller C, Lima FV, Butler J, Stergiopoulos K. Impact of heart disease on maternal and fetal outcomes in pregnant women. Am J Cardiol. 2015;116(3):474–80.CrossRef Koutrolou-Sotiropoulou P, Parikh PB, Miller C, Lima FV, Butler J, Stergiopoulos K. Impact of heart disease on maternal and fetal outcomes in pregnant women. Am J Cardiol. 2015;116(3):474–80.CrossRef
10.
go back to reference Vause S, Clarke B, Tower CL, Hay C, Knight M. Pregnancy outcomes in women with mechanical prosthetic heart valves: a prospective descriptive population based study using the United Kingdom obstetric surveillance system (UKOSS) data collection system. BJOG. 2017;124(9):1411–9.CrossRef Vause S, Clarke B, Tower CL, Hay C, Knight M. Pregnancy outcomes in women with mechanical prosthetic heart valves: a prospective descriptive population based study using the United Kingdom obstetric surveillance system (UKOSS) data collection system. BJOG. 2017;124(9):1411–9.CrossRef
11.
go back to reference West R, West S, Simons R, McGlennan A. Impact of dose-finding studies on administration of oxytocin during caesarean section in the UK. Anaesthesia. 2013;68(10):1021–5.CrossRef West R, West S, Simons R, McGlennan A. Impact of dose-finding studies on administration of oxytocin during caesarean section in the UK. Anaesthesia. 2013;68(10):1021–5.CrossRef
12.
go back to reference www.hradecisiontools.org.uk/research (last accessed 05/07/2018). www.hradecisiontools.org.uk/research (last accessed 05/07/2018).
Metadata
Title
Estimated blood loss in pregnant women with cardiac disease compared with low risk women: a restrospective cohort study
Authors
Hsu Phern Chong
James Hodson
Tara J. Selman
Lucy E. Hudsmith
Peter J. Thompson
Rachel Katherine Morris
Sara Thorne
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2019
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-019-2447-8

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