Abstract

Massive haemorrhage causes 30% of maternal deaths worldwide and remains the third commonest direct cause of death in the UK, occurring more often in association with Caesarean than vaginal birth. The authors have investigated the hypothesis that preoperative anaemia predisposes women having a Caesarean to increased blood loss and increases the use of blood products.

100 case notes were reviewed from women having an elective repeat Caesarean in a UK hospital, with exclusions: more than previous Caesarean, parity >3, low-lying placenta, APH (antepartum haemorrhage), clotting abnormalities, multiple pregnancy, ruptured membranes, haemoglobinopathy and/or use of antenatal iron therapy. For included cases, preoperative (Hb), MCV (mean cell volume), estimated peri-operative blood loss, cause of blood loss and transfusion of blood products were recorded. Clinical teams performing the Caesareans were unaware of the study until its completion.

Mean blood loss in women with preoperative (Hb) ≥11 g/dl was 401 ml ± SD 201 ml, while mean blood loss in anaemic women was 656 ± 583 ml (p<0.001). Defining postpartum haemorrhage (PPH) as peri-operative bleeding ≥1000 ml, 2/52 women without anaemia had a PPH compared to 10/48 women with anaemia (p<0.005). 1/52 women without anaemia received blood products compared to 5/48 women with anaemia (p<0.001). Mean blood loss in normocytic women (≥83 fl) was 474±401 ml, while microcytic women had a mean blood loss of 876±569 ml (p<0.001). 8/83 normocytic women and 4/17 microcytic women had a PPH (p<0.001). 3/83 normocytic women were transfused compared to 3/17 microcytic women (p<0.001).

Links between maternal haemorrhage and anaemia/microcytosis will be discussed in this presentation and clinical consequences considered.