Postpartum hemorrhage does not impact future pregnancies

Jan 29 2013

By medwireNews Reporters

Postpartum hemorrhage (PPH) with a first pregnancy does not have a detrimental effect on second pregnancies, research shows.

Prior PPH did not result in a delay in achieving a second pregnancy and the proportion of early or late second pregnancy losses was comparable in women without a PPH in their first pregnancy.

"It is reassuring for women that there is no overall reduction in numbers returning for a second pregnancy following an initial PPH," write Gail Fullerton (Aberdeen Maternity Hospital, UK) and colleagues. "This is important, as it can be a very traumatic event and such information may provide reassurance to women when counselling them following a PPH."

Published in the British Journal of Obstetrics and Gynaecology, the cohort study included 34,334 women with a first delivery in the Aberdeen Maternity and Neonatal Databank.

In all, 10% had a PPH in their first pregnancy, and PPH was associated with older age, increasing body mass index, and smoking.

In total, 2673 (78.0%) women who had a PPH after their first baby had a second pregnancy. This was comparable with the 80.0% of women without PPH who had a second pregnancy. The median time to the second pregnancy was 5 years in both the PPH and non-PPH groups.

The live birth rate was also comparable between the two groups, at 77.5% among women with prior PPH, and 75.6% among women without PPH.

There was, however, a significant decrease in subsequent pregnancies following a PPH at the time of a cesarean section which requires further research, report Fullerton and colleagues.

"Trying to ascertain the reasons behind the reduced pregnancy rate may highlight issues about fertility and women's views on the initial event," the researchers write.

Additionally, in the second pregnancy, 18% of women with a PPH in the first pregnancy had another PPH. This was significantly higher than the 6.9% rate of PPH among women who did not have a PPH in their first pregnancy.

"We have shown there is a 2.9 times higher recurrence rate of PPH in a second pregnancy, compared with those who do not have a PPH, which is in keeping with the results in other recent studies," conclude Fullerton et al.

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