Relationship between anaemia, coagulation parameters during pregnancy and postpartum haemorrhage at childbirth: a prospective cohort study
Manisha Nair, Shakuntala Chhabra, Saswati Sanyal Choudhury, Dipika Deka, Gitanjali Deka, Swapna D. Kakoty, Pramod Kumar, Pranabika Mahanta, Robin Medhi, Anjali Rani, Seeresha Rao, Indrani Roy, Carolin Solomi, Ratna Kanta Talukdar, Farzana Zahir, Nimmi Kansal, Anil Arora, Charles Opondo, Jane Armitage, Michael Laffan, Simon Stanworth, Maria Quigley, Colin Baigent, Marian Knight, Jennifer J. Kurinczuk
Abstract
OBJECTIVES: To investigate the association between coagulation parameters and severity of anaemia (moderate anaemia: haemoglobin (Hb) 7-9.9 g/dL and severe anaemia: Hb <7 g/dL) during pregnancy and relate these to postpartum haemorrhage (PPH) at childbirth. DESIGN: A prospective cohort study of pregnant women recruited in the third trimester and followed-up after childbirth. SETTING: Ten hospitals across four states in India. PARTICIPANTS: 1342 pregnant women. INTERVENTION: Not applicable. METHODS: Hb and coagulation parameters: fibrinogen, D-dimer, D-dimer/fibrinogen ratio, platelets and international normalised ratio (INR) were measured at baseline. Participants were followed-up to measure blood loss within 2 hours after childbirth and PPH was defined based on blood loss and clinical assessment. Associations between coagulation parameters, Hb, anaemia and PPH were examined using multivariable logistic regression models. OUTCOMES MEASURES: Adjusted OR with 95% CI. RESULTS: /L lower compared with women with moderate anaemia. Similar relationships with smaller effect sizes were identified for women with moderate anaemia compared with women with no/mild anaemia. Low Hb and high INR at third trimester of pregnancy independently increased the odds of PPH at childbirth, but the other coagulation parameters were not found to be significantly associated with PPH. CONCLUSION: Altered blood coagulation profile in pregnant women with severe anaemia could be a risk factor for PPH and requires further evaluation.