Abstract
Objective The study aimed to evaluate the impact of obesity on the management and outcomes
of postpartum hemorrhage.
Study Design We conducted a retrospective cohort study of women who delivered at a tertiary care
center between February 1, 2013 and January 31, 2014 and experienced a postpartum
hemorrhage. Charts were reviewed for clinical and sociodemographic data, and women
were excluded if the medical record was incomplete. Hemorrhage-related severe morbidity
indicators included blood transfusion, shock, renal failure, transfusion-related lung
injury, cardiac arrest, and use of interventional radiology procedures. Obese (body
mass index [BMI] ≥ 30 kg/m2) and nonobese women were compared. Data were analyzed using Chi-square, Student's
t-test, Mann–Whitney U test, and linear regression where appropriate. The p-value <0.05 was significant.
Results Of 9,890 deliveries, 2.6% (n = 262) were complicated by hemorrhage. Obese women were more likely to deliver by
cesarean section (55.5 vs. 39.8%, p = 0.016), undergo a cesarean after labor (31.1 vs. 12.2%, p = 0.001), and have a higher quantitative blood loss (1,313 vs. 1,056 mL, p = 0.003). Both groups were equally likely to receive carboprost, methylergonovine,
and misoprostol, but obese women were more likely to receive any uterotonic agent
(95.7 vs. 88.9%, p = 0.007) and be moved to the operating room (32.3 vs. 20.4, p = 0.04). There was no difference in the use of intrauterine pressure balloon tamponade,
interventional radiology, or decision to proceed with hysterectomy. The two groups
were similar in time to stabilization. There was no difference in the need for blood
transfusion. Obese women required more units of blood transfused (2.2 ± 2 vs. 2 ± 5
units, p = 0.023), were more likely to have any hemorrhage-related severe morbidity (34.1
vs. 25%, p = 0.016), and more than one hemorrhage related morbidity (17.1 vs. 7.9, p = 0.02). After controlling for confounding variables, quantitative blood loss, and
not BMI was predictive of the need for transfusion.
Conclusion Despite similar management, obese women were more likely to have severe morbidity
and need more units of blood transfused.
Key Points
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Obese women were more likely to have a higher quantitative blood loss and require
more units of blood transfused.
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Obese women were more likely to experience any hemorrhage-related severe morbidity.
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Although obese women were more likely to be moved to the operating room for intervention,
the rates of intrauterine pressure balloon tamponade, interventional radiology or
hysterectomy were the same for obese and non-obese women.
Keywords
maternal morbidity - maternal mortality - obstetric hemorrhage - postpartum - obesity
- blood transfusion
