Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX; Parkland Health and Hospital System, Dallas, TX.
Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX.
Am J Obstet Gynecol MFM. 2022 Mar;4(2):100541. doi: 10.1016/j.ajogmf.2021.100541. Epub 2021 Dec 4.
Postpartum anemia is common after delivery, and postpartum blood transfusion is the leading indicator of severe maternal morbidity in the United States. Although hematologic changes during the antepartum period are well understood, little is known about postpartum hematologic changes. Therefore, we investigated the hematologic changes in the postpartum period in a large, contemporary cohort.
This study aimed to characterize hematologic recovery in the postpartum period and evaluate the effect of demographics, medical conditions, and pregnancy characteristics on the recovery.
In a contemporary cohort of deliveries in 2019 at a single institution, the hematocrit of postpartum women before hospital discharge was compared with the hematocrit of women at the postpartum follow-up. Our population was composed of a predominantly Hispanic population at an urban, safety-net hospital. All women received a complete blood count on postpartum day 1 and a spun hematocrit at their postpartum follow-up visit in our hospital system. All women were scheduled for a routine postpartum visit 2 to 3 weeks after delivery. All deliveries of a live-born infant with available postpartum hematocrit before hospital discharge and at postpartum follow-up were included. Demographics and pregnancy characteristics, along with medical conditions, were evaluated. To evaluate an uncomplicated cohort, those with multiple gestation, preeclampsia with severe features, chronic hypertension, and diabetes mellitus were excluded in the secondary analysis. Statistical analysis included chi-square, paired Student t test, Student t test for independent groups, and analysis of variance.
Of 12,456 deliveries, 9003 met the inclusion criteria. The average number of days from discharge to follow-up was 21.73±10.39 days. The average hematocrit levels were 30.77±3.61 before discharge and 38.70±3.61 at postpartum follow-up. From discharge to postpartum follow-up, the hematocrit levels increased by an average of 7.93±3.24. In the cohort without complications, the average increase in hematocrit levels was 8.19±3.09. The rise in hematocrit levels was significantly lower for those with chronic hypertension (6.9±3.6), diabetes mellitus (7.3±3.3), and preeclampsia with severe features (6.9±3.7). The severity of anemia influenced the rise in hematocrit levels in the postpartum period. In women with postpartum anemia (hematocrit<30%), the rise in hematocrit levels was 9.49±2.97 in the uncomplicated cohort. Postpartum hemorrhage did not influence the rise in postpartum hematocrit levels; women receiving blood transfusion had a greater rise in hematocrit levels (9.01±3.29).
Our study establishes the natural course of hematologic recovery in the postpartum period, and we found that women with asymptomatic postpartum anemia may have a hematocrit level of 37% to 39% at their postpartum follow-up approximately 3 weeks after hospital discharge. Women with preexisting and obstetrical complications experienced less hematologic recovery and adapted more slowly to postpartum physiological changes.
产后贫血在分娩后很常见，产后输血是美国严重产妇发病率的主要指标。尽管产前期间的血液变化众所周知，但对产后血液变化知之甚少。因此，我们研究了大量当代队列中的产后血液变化。
本研究旨在描述产后血液恢复情况，并评估人口统计学、医疗状况和妊娠特征对恢复的影响。
在 2019 年某单一机构的当代分娩队列中，比较了出院前产妇的血细胞比容与产后随访时的血细胞比容。我们的人群主要由城市安全网医院的西班牙裔人口组成。所有女性在产后第 1 天接受全血细胞计数，并在我们医院系统的产后随访时接受离心血细胞比容。所有女性都被安排在分娩后 2 至 3 周进行常规产后检查。所有活产婴儿的分娩都包括出院前和产后随访时可用的产后血细胞比容。评估了人口统计学和妊娠特征以及医疗状况。为了评估无并发症队列，排除了多胎妊娠、重度子痫前期、慢性高血压和糖尿病。统计分析包括卡方检验、配对学生 t 检验、独立组学生 t 检验和方差分析。
在 12456 次分娩中，有 9003 次符合纳入标准。从出院到随访的平均天数为 21.73±10.39 天。平均血细胞比容水平为 30.77±3.61 出院前和 38.70±3.61 在产后随访时。从出院到产后随访，血细胞比容平均增加 7.93±3.24。在无并发症的队列中，血细胞比容水平的平均增加为 8.19±3.09。慢性高血压（6.9±3.6）、糖尿病（7.3±3.3）和重度子痫前期（6.9±3.7）患者的血细胞比容升高幅度明显较低。贫血的严重程度影响产后期间血细胞比容的升高。在产后贫血（血细胞比容<30%）的女性中，无并发症队列的血细胞比容升高 9.49±2.97。产后出血并不影响产后血细胞比容水平升高；接受输血的女性血细胞比容水平升高更大（9.01±3.29）。
本研究确立了产后血液恢复的自然过程，我们发现大约在出院后 3 周的产后随访时，无症状产后贫血的女性可能有 37%至 39%的血细胞比容水平。有既往和产科并发症的女性经历较少的血液学恢复，并且对产后生理变化的适应较慢。
