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Grand Rounds

Does Risk of Postpartum Hemorrhage Increase with Familial History of PPH?

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BACKGROUND AND PURPOSE:

  • Data is limited regarding
    • PPH and impact of family history
    • Extent that birthweight influences PPH recurrence between relatives
  • Linde et al. (Acta Obstet Gynecol Scand, 2021) investigated family aggregation of PPH and how birthweight influences these effects

METHODS:

  • Population-based cohort study
    • Data derived from
      • The Medical Birth Registry of Norway
      • Statistics Norway
      •  Central Population Registry of Norway
  • Population
    • Born in Norway and their family members
    • Using the above databases, population-based pedigrees could be constructed
    • Individuals identified as either newborns, parents, grandparents and full or half-siblings
  • Exposures
    • PPH in family member
  • Study design
    • Multilevel logistic regression was used to calculate odds ratios (OR) with 95% CI
  • Primary outcome
    • PPH in newborn birth

RESULTS:

  • Mother-offspring pairs: 1,002,687 | Father-offspring pairs: 841,164 | Both parent-offspring pairs: 761,011
  • Births of family members that involved PPH were associated with an increased odds of PPH in the offspring’s birth
    • When mother’s birth involved PPH: 1.44 (95% CI 1.39 to 1.49)
    • When father’s birth involved PPH: 1.12 (95% CI, 1.08 to 1.16)
  • Effects more pronounced with severe PPH
  • Recurrence between siblings was highest between full sisters
    • OR 1.47 (95% CI 1.41 to 1.52)
  • Highest recurrence occurred, in descending order, between
    • Maternal half-sisters
    • Paternal half-sisters
    • Partners of full brothers
  • The following factors contributed to total number of PPH cases
    • Family history of PPH: Accounted for ≤5% of the total number of PPH cases
    • Family history of birthweight of >4000 g: 15% of the total number of PPH cases

CONCLUSION:

  • A history of PPH in relatives was associated with an increased odds of PPH recurrence
    • This increased risk was greater in when the relative was more closely related to the focal birth
    • Recurrence was highest through the maternal line
  • The authors state

Women with a family history of PPH had an increased risk of PPH in a dose–response pattern consistent with the anticipated proportion of shared genes in relatives

This risk was strongly modified by current birthweight

On a population level, a history of PPH in relatives accounted for a low number of PPH cases, whereas the current birthweight accounted for a more significant number of PPH cases

Learn More – Primary Sources:

Recurrence of postpartum hemorrhage in relatives: A population-based cohort study

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Related ObG Topics:

Postpartum Hemorrhage – Medications to Treat Uterine Atony 
Latest Cochrane Review: What is the Most Effective Prophylactic Treatment for Postpartum Hemorrhage?
What Are the Risk Factors for Postpartum Hemorrhage Due to Uterine Atony?
How Effective is Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage

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