Does Abnormal Uterine Bleeding in Menstrual Cycles Predispose Postpartum Bleeding? A Prospective Study

Objective: Postpartum bleeding is a life-threatening obstetric problem all over the world, which needs to be well managed to reduce maternal mortality. In this study, we aim to predict postpartum bleeding by menstrual cycles of the patients. Methods: A prospective, observational, cross-sectional study was conducted between November 2017 and July 2018. All the patients that gave labour in our clinic were evaluated and grouped. Group 1 (n=240) consisted of the patients with regular menstrual cycles, and they had no history of bleeding disorders, Group 2 (n=60) consisted of the patients with abnormal uterine bleeding as >80 mL bleeding in a period, having period before 24 days, >8 days of bleeding in a period or intermenstrual bleeding. However, they had no other history of bleeding disorder. All the patients were screened for bleeding diathesis. Results: The mean age was 28.77±5.88 years and the mean prepartum hemoglobin was 11.76±1.36 mg/dl. 118 (39.3%) of the patients had a vaginal delivery and 182 (60.7%) had a cesarean delivery. The mean postpartum hemoglobin was 10.71±1.49 mg/dl. Group 1 had higher prepartum and postpartum hemoglobin than Group 2 (p=0.001 and p=0.003, respectively). Abnormal uterine bleeding (AUB) was correlated with prepartum (r=0.222, p=0.000) and postpartum hemoglobin (r=0.171, p=0.030). AUB was not significantly related to postpartum bleeding. Regarding fetal outcome, only neonatal intensive care unit admission was significantly related to abnormal uterine bleeding history (p=0.03). Conclusion: Postpartum bleeding is not always a predictable status, and patients with abnormal uterine bleeding history should be expected to have lower hemoglobin levels prepartum and postpartum.

Postpartum Hemorajide Mens Dönemi Menometroraji Predispozan Bir Faktör müdür? Prospektif Bir Çalışma

Amaç: Doğum sonrası kanama tüm dünyada önemli bir sorundur ve maternal ölüm oranını azaltmak için çözülmesi gerekmektedir. Amacımız doğum sonrası kanamayı jinekolojik anamnez yoluyla tahmin etmekti. Gereç ve Yöntem: Kasım 2017-Temmuz 2018 tarihleri arasında prospektif gözlemsel bir kesit çalışması yapıldı. Doğum için başvuran tüm hastalar değerlendirildi ve gruplandı. Grup 1 (n=240), düzenli adetleri olduğunu ve kanama bozukluğu öyküsü olmadığını iddia eden hastalardan oluşturuldu. Grup 2 (n=60), anormal uterin kanaması olan (menstrüasyonda >80 mL kanama ve/veya 8 günden daha uzun süreli adet dönemi ve/veya 24 günden daha kısa süreli siklus ve/veya adetler arası kanama) hastalardan oluşuyordu ve başka bir kanama bozukluğu öyküsü yoktu. Hastalar kanama diatezi açısından araştırıldı. Bulgular: Ortalama yaş 28.77±5.88 yıl ve ortalama doğum öncesi hemoglobin değeri 11.76±1.36 mg/dl idi. Hastaların 118'i (%39.3) vajinal doğum, 182'si (%60.7) sezaryen ile doğum yaptı. Ortalama doğum sonrası hemoglobin değeri 10.71±1.49 mg/dl idi. Grup 1'de doğum öncesi ve doğum sonrası hemoglobin değerleri Grup 2'ye göre daha yüksekti (sırasıyla, p=0.001 ve p=0.003). Anormal uterin kanama (AUK), prepartum (r=0.222, p=0.000) ve postpartum hemoglobin değerleri ile koreleydi (r=0.171, p=0.030). Grup 1'de postpartum ve postpartum hematokrit değerleri Grup 2'den yüksek bulundu (sırasıyla, p=0.001 ve p=0.021). AUK, doğum sonrası kanama ile ilişkili bulunmadı. Fetal sonuçlarla alakalı olarak (1. dakika ve 5. dakika APGAR skoru, yenidoğan YBÜ giriş ve doğum ağırlığı), sadece yenidoğan YBÜ kabulü, anormal uterin kanamaya sahip olmakla anlamlı şekilde ilişkiliydi (p=0.03). Sonuç: Doğum sonrası kanama her zaman öngörülebilir bir durum değildir ve doğum öncesi anormal uterin kanama anamnezi olan hastaların hemoglobin düzeylerinin doğum öncesi ve doğum sonrasında daha düşük olması beklenebilir.

Kaynakça

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Kaynak Göster

Southern Clinics of Istanbul Eurasia
  • ISSN: 2587-0998
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2017

1b344

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