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Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India
Cheng, Tuck Seng Zahir, Farzana Solomi, Carolin Verma, Ashok Rao, Sereesha Choudhury, Saswati Sanyal Deka, Gitanjali Mahanta, Pranabika Kakoty, Swapna Medhi, Robin
Cheng, Tuck Seng
Zahir, Farzana
Solomi, Carolin
Verma, Ashok
Rao, Sereesha
Choudhury, Saswati Sanyal
Deka, Gitanjali
Mahanta, Pranabika
Kakoty, Swapna
Medhi, Robin
Authors
Cheng, Tuck Seng
Zahir, Farzana
Solomi, Carolin
Verma, Ashok
Rao, Sereesha
Choudhury, Saswati Sanyal
Deka, Gitanjali
Mahanta, Pranabika
Kakoty, Swapna
Medhi, Robin
Chhabra, Shakuntala
Rani, Anajali
Bora, Amrit
Roy, Indrani
Minz, Bina
Bharti, Omesh Kumar
Deka, Rupanjali
Opondo, Charles
Churchill, David
Knight, Marian
Kurinczuk, Jennifer J.
Nair, Manisha
Zahir, Farzana
Solomi, Carolin
Verma, Ashok
Rao, Sereesha
Choudhury, Saswati Sanyal
Deka, Gitanjali
Mahanta, Pranabika
Kakoty, Swapna
Medhi, Robin
Chhabra, Shakuntala
Rani, Anajali
Bora, Amrit
Roy, Indrani
Minz, Bina
Bharti, Omesh Kumar
Deka, Rupanjali
Opondo, Charles
Churchill, David
Knight, Marian
Kurinczuk, Jennifer J.
Nair, Manisha
Editors
Other contributors
Epub Date
Issue Date
2024-11-08
Submitted date
Alternative
Abstract
Objective: To investigate whether induction/augmentation of labor in pregnant women with anemia increases the risk of postpartum hemorrhage (PPH) and whether this risk varied by indications for labor induction/augmentation and by anemia severity in pregnancy. Methods: In a prospective cohort study of 9420 pregnant women from 13 hospitals across India, we measured hemoglobin concentrations at recruitment (≥28 weeks of gestation) and blood loss after childbirth during follow-up and collected clinical information about PPH. Clinical obstetric and childbirth information at both visits were extracted from medical records. Anemia severity in the third trimester was categorized using hemoglobin concentrations (no/mild anemia: hemoglobin ≥10 g/dL; moderate: hemoglobin 7 to 9.9 g/dL; severe: hemoglobin <7 g/dL), while PPH was defined based on blood loss volume (vaginal births: ≥500 mL or cesarean sections: ≥1000 mL) and clinical diagnosis. Indications for labor induction/augmentation were classified as clinically indicated and elective as per guidelines. We performed multivariable modified Poisson regression analyses to investigate the associations of anemia severity and indications for labor induction/augmentation, including their interaction, with PPH, adjusted for potential confounders. Results: PPH was associated with anemia but not with indications for labor induction/augmentation. However, there was a significant interaction between the two factors in relation to PPH (P = 0.003). Among pregnant women with severe anemia, a higher risk of PPH was associated with elective (adjusted risk ratio, 3.44 [95% confidence interval, 1.29–9.18]) but not with clinically indicated (adjusted risk ratio, 1.22 [95% confidence interval, 0.42–3.55]) labor induction/augmentation. No associations were observed among pregnant women with no/mild and moderate anemia. Conclusion: The risk of PPH is higher in women who have moderate–severe anemia in late pregnancy. Induction/augmentation of labor is generally safe for women with anemia, but it can increase the risk of PPH in women with severe anemia if performed electively.
Citation
Cheng, T.S., Zahir, F., Solomi V, C. et al. (2025) Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India. International Journal of Gynecology and Obstetrics, 169(1), pp. 299-309.
Publisher
Research Unit
PubMed ID
39513665 (pubmed)
PubMed Central ID
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Type
Journal article
Language
en
Description
© 2024 The Authors, published by Wiley. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1002/ijgo.16008
Series/Report no.
ISSN
0020-7292
EISSN
1879-3479
ISBN
ISMN
Gov't Doc #
Sponsors
The MaatHRI platform and this study was funded by a Medical Research Council (grant number MR/P022030/1) and a Transition Support Award (grant number MR/W029294/1) for MN.