Significantly higher postpartum hemorrhage with preterm vs. term pregnancies
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Key takeaways:
- Maternal morbidity increased by 30.4% in preterm vs. term births.
- The most prevalent complications for both term and preterm births were postpartum hemorrhage, use of a uterotonic agent and transfusion.
BALTIMORE — Preterm deliveries were associated with significantly higher postpartum hemorrhagic composite maternal morbidity rates compared with term pregnancies, according to data presented at the ACOG Annual Clinical & Scientific Meeting.
“There is limited data examining postpartum hemorrhage rates and premature deliveries, and the limited data that is out there focuses primarily on route of delivery,” Stephen Wagner, MD, an obstetrician and gynecologist at the Women & Infants Hospital of Rhode Island and the Alpert Medical School of Brown University, Providence, said during a presentation. “Previous studies identified women with cesarean birth at increased risk for maternal hemorrhagic morbidity when compared to preterm vaginal deliveries, consistent with data from term pregnancies as well.”
In this secondary analysis of a retrospective cohort study of 4,514 in-house singleton deliveries over 1 year, researchers extracted data and categorized cohorts by term (n = 3,452) and preterm (n = 1,062) births defined as cut-off at 37 weeks. The primary outcomes were blood loss of 1,000 mL or greater, uterotonic use, transfusion, uterine tamponade, surgical interventions, ICU admission, hysterectomy and hemorrhage-related maternal mortality.
Researchers observed significantly higher rates of induction at term (65.9% vs. 40.6%), significantly lower rates of prior cesarean at term (21.5% vs. 30.1%) and statistically higher vaginal delivery rates (55.5% vs. 41.4%) among term pregnancies compared with preterm pregnancies. Overall composite maternal morbidity was significantly increased among preterm pregnancies — 30.4% compared with 21% among term pregnancies (RR = 1.44; 95% CI, 1.30-1.62). This increase remained following adjustments (RR = 1.42; 95% CI, 1.27-1.60).
In addition, the most prevalent complications observed among both term and preterm births were postpartum hemorrhage (6.2% and 12.2%), use of a uterotonic agent (16% and 19.4%) and transfusion (2.6% and 8.9%).
“Moving forward we are collecting additional data over the subsequent years to examine some of the rare complications and outcomes, and we're in the early stages of developing interventional trials to prevent this inequality and severe hemorrhage in this population,” Wagner said.