ANAEMIA AND POSTPARTUM HAEMORRHAGE (PPH)
Anaemia is a cause and consequence of PPH. A cohort study in Assam, India found that women with moderate or severe anaemia had a greatly increased risk of PPH (1). Women with moderate anaemia had a 50% increased risk of PPH, whereas those with severe anaemia had a ten-fold increased risk. The reasons for the increased risk is unclear but some researchers think that anaemic women are more susceptible to uterine atony due to impaired oxygen transport to the uterus.
Anaemic women experience worse outcomes after PPH. An international survey of 275,000 women found that severe maternal outcomes after PPH were nearly three times more common in anaemic than in non-anaemic women (2).
Even moderate bleeding can be life threatening in anaemic women. Excessive bleeding after childbirth worsens maternal anaemia, raising the possibility of a vicious circle of bleeding and adverse outcomes. Fatigue due to anaemia limits a mother’s wellbeing and her ability to care for her children (3).
Despite efforts to prevent anaemia, many women labour with low haemoglobin levels. Worldwide, over one-third of pregnant women are anaemic and many are severely anaemic (4). The prevalence is highest in countries in central and West Africa as well as in South Asia where about half of pregnant woman are anaemic and it poses a severe public health problem (4, 5).
There is an urgent need to find an effective way to reduce postpartum bleeding in anaemic women.
Nair M, Choudhry MK, Choudhry SS, Kakoty SD, Sarma UC, Webster P, et al. Association between maternal anaemia and pregnancy outcome: a cohort study in Assam, India. BMJ Global Health. 2016;1(e000026).
Sheldon WR, Blum J, Vogel JP, Souza JP, Gulmezoglu AM, Winikoff B, et al. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014;121 Suppl 1:5-13.
Geller S, Adams M, Kelly P, Kodkany B, Derman R. Postpartum hemorrhage in resource poor-settings. International Journal of Gynecology and Obstetrics 2006;92:202-211.
Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Glob Health 2013;1(1):e16-25.
WHO. Global prevalence of anaemia in 2011. http://apps.who.int/iris/bitstream/10665/177094/1/9789241564960_eng.pdf 2008.