The following news story appeared in Essentially MIDIRS, vol 4, no 3, March 2013, p24.
BJOG: An International Journal of Obstetrics and Gynaecology has released for ‘early view’ (an online preview of an upcoming paper) a study (Fullerton et al 2013) showing that, while women who experience postpartum haemorrhage (PPH) during their first birth are not more likely to experience problems with future fertility, women who have a caesarean section during which a PPH occurs are less likely to conceive again.
The cohort study was carried out at the Aberdeen Maternity Hospital in Scotland and looked retrospectively at the maternity records of women who gave birth between 1986 and 2005. Information was gathered from the Aberdeen Maternity and Neonatal Databank and it was initially discovered that 10% of the 34,334 women whose first pregnancies were recorded in the Databank were recorded as having experienced a PPH. The researchers then looked forward in the Databank to identify cases of subsequent pregnancy in these women.
The mode of delivery among women who had experienced PPH during their first pregnancy was a significant factor affecting the likelihood of a second pregnancy. Of those women who initially had a caesarean section which was complicated by PPH, 41.5% did not conceive a second pregnancy. This was in comparison to 36.8% of women who had a caesarean section that was not complicated by PPH and, as John Thorp, BJOG Deputy Editor-in-Chief also added, ‘…there is no overall reduction in the numbers returning for a second pregnancy following an initial PPH complication’.
The study also showed that women who had a PPH experienced a high recurrence rate and were 2.9 times more likely to experience PPH during their second pregnancy than those who had no initial exposure (18% versus 6.9%). The authors concluded that:
‘From this cohort study we can conclude that if a PPH occurs in a first pregnancy, there is no delay in achieving a second pregnancy, and no detrimental effect on the outcome of that pregnancy. Significantly fewer women conceive a second pregnancy if they have a caesarean section in their first pregnancy that is complicated by PPH’ (Fullerton et al 2013).
Lead author Gail Fullerton further commented that:
‘While experiencing PPH in an initial pregnancy increases the risk of recurrence in subsequent pregnancies, it should not be cause for concern in relation to future fertility’.
‘The women in our study showed no adverse affects to the likelihood or timing of future pregnancies after an initial PPH complication’.
‘However, it is clear that more research needs to be done to ascertain why there is a significant decrease in a subsequent pregnancy following PPH at time of an initial c-section delivery’.
It is impossible to tell from this study whether caesarean section complicated by PPH itself decreases fertility, or whether women who have experienced this combination of events may be less likely to try to become pregnant again.
Fullerton G, Danielian P, Bhattacharya S (2013). Outcomes of pregnancy following postpartum haemorrhage. BJOG: An International Journal of Obstetrics and Gynaecology. 23 January [Online version ahead of print]. http://tinyurl.com/apt9cj3 [Accessed 30 January 2013].
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