Am J Obstet Gynecol MFM. 2021 Dec 4:100541. doi: 10.1016/j.ajogmf.2021.100541. Online ahead of print.
ABSTRACT
BACKGROUND: Postpartum anemia is common after delivery, and postpartum blood transfusion is the leading indicator of Severe Maternal Morbidity in the United States. While hematologic changes during the antepartum period are well understood, less is known about postpartum hematologic changes. We investigated hematologic changes in the postpartum period in a large, contemporary cohort.
OBJECTIVE: To characterize postpartum period hematologic recovery and evaluate the effect of demographics, medical conditions, and pregnancy characteristics on the recovery.
STUDY DESIGN: In a contemporary cohort of deliveries in 2019 at a single institution, the hematocrit of postpartum women prior to hospital discharge was compared to hematocrit at the postpartum follow-up. Our population was composed of a predominantly Hispanic population at an urban, safety net hospital. All women receive a CBC on postpartum day one and a spun hematocrit at their postpartum follow-up visit in our hospital system. All women are scheduled for a routine postpartum visit 2-3 weeks postpartum. All deliveries of a liveborn infant with available postpartum hematocrit prior to 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 were excluded in secondary analysis. Statistical analysis included chi-square, paired Student’s t-test, Student’s t-test for independent groups, and analysis of variance.
RESULTS: Of the 12,456 deliveries, 9,003 met inclusion criteria. The average number of days from discharge to follow-up was 21.73±10.39 days. The average hematocrit prior to discharge was 30.77±3.61 and at postpartum follow-up 38.70±3.61. Hematocrit increased from discharge to postpartum follow-up an average of 7.93±3.24. In the cohort without complications, the average increase in hematocrit was 8.19±3.09. The rise of hematocrit was significantly lower for those with chronic hypertension (6.9±3.6%), diabetes (7.3±3.3%), and preeclampsia with severe features (6.9±3.7%). The severity of anemia influenced the rise in hematocrit in the postpartum period. In women with postpartum anemia (hematocrit <30%), the rise in hematocrit was 9.49±2.97 in the uncomplicated cohort. Postpartum hemorrhage did not influence rise in postpartum hematocrit; women receiving blood transfusion had a greater rise in hematocrit (9.01±3.29).
CONCLUSION: Our study establishes the natural course of hematologic recovery in the postpartum period, and we found women with asymptomatic postpartum anemia will have a hematocrit of 37-39% at their postpartum follow-up approximately 3 weeks after hospital discharge. Women with pre-existing and obstetric complications experience less hematologic recovery and adapt more slowly to postpartum physiological changes.
PMID:34875414 | DOI:10.1016/j.ajogmf.2021.100541
