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CONFERENCE PROCEEDING
The association between the trend in body mass index and the trend in postpartum hemorrhages and manual placental removal: A Dutch cohort study
1
AmsterdamUMC/UvA, Midwifery Science, Utrecht, Netherlands
2
Amsterdam University Medical Center, Midwifery Science, Amsterdam, Netherlands
Eur J Midwifery 2026;10(Supplement 1):A532
ABSTRACT
BACKGROUND:
There is a global increase in postpartum hemorrhage (PPH) and manual placental removal (MROP), for which is no sufficient explanation. Additionally there is a trend towards increased Body Mass Index (BMI) among childbearing population. The relation between these is unclear (1-4). Midwife-led care demonstrates improved outcomes for women; home-birth, in particular may be an ameliorating factor (5-7).
OBJECTIVES:
To investigate the association between BMI and PPH and MROP in midwife-led care in the Netherlands
METHODS:
This retrospective cohort study used the VeCas database, containing representative data for the midwife-led population in the Netherlands (8). Informed consent prior to inclusion in the database was obtained. Births (singleton and term) in midwife-led care between 2013 and 2022 were included ( n=29,021). Uni- and multivariable logistic regression analyses examined associations between year and PPH ≥ 1000 mL and MROP, and BMI categories and PPH and MROP.
RESULTS:
The incidence of normal- and underweight decreased from 69% to 61%, and from 3.7% to 3.4%. The incidence of overweight and obesity class I increased from 20% to 25% and from 5.7% to 7.9% (p-value <0.001). PPH and MROP rates increased, respectively 1.9% to 3.5% (OR1.9,(95%CI(1.32-2.74) and 1.5% to 4.5% (OR3.0(2.05-4.44), compared to the reference year. Adjusted OR’s with and without BMI didn’t materially alter (p-value <0.001). Increasing BMI category was associated with higher OR’s for PPH in obesity class II OR 1.63(1.09-2.45) and MROP (2.96(2.10-4.16), with greater increase in MROP observed.
CONCLUSIONS:
This study confirms the upward trend in both BMI and the incidence of PPH and MROP in healthy childbearing women. No evidence was identified linking the rise in BMI to the ongoing increase in PPH and MROP.
KEY MESSAGE:
Critically evaluate third stage management, as overtreatment may contribute to rising PPH and MROP rates. Emphasize watchful attendance (9) and inform women about the protective effect of home birth. Poster session 1 (Group A)
There is a global increase in postpartum hemorrhage (PPH) and manual placental removal (MROP), for which is no sufficient explanation. Additionally there is a trend towards increased Body Mass Index (BMI) among childbearing population. The relation between these is unclear (1-4). Midwife-led care demonstrates improved outcomes for women; home-birth, in particular may be an ameliorating factor (5-7).
OBJECTIVES:
To investigate the association between BMI and PPH and MROP in midwife-led care in the Netherlands
METHODS:
This retrospective cohort study used the VeCas database, containing representative data for the midwife-led population in the Netherlands (8). Informed consent prior to inclusion in the database was obtained. Births (singleton and term) in midwife-led care between 2013 and 2022 were included ( n=29,021). Uni- and multivariable logistic regression analyses examined associations between year and PPH ≥ 1000 mL and MROP, and BMI categories and PPH and MROP.
RESULTS:
The incidence of normal- and underweight decreased from 69% to 61%, and from 3.7% to 3.4%. The incidence of overweight and obesity class I increased from 20% to 25% and from 5.7% to 7.9% (p-value <0.001). PPH and MROP rates increased, respectively 1.9% to 3.5% (OR1.9,(95%CI(1.32-2.74) and 1.5% to 4.5% (OR3.0(2.05-4.44), compared to the reference year. Adjusted OR’s with and without BMI didn’t materially alter (p-value <0.001). Increasing BMI category was associated with higher OR’s for PPH in obesity class II OR 1.63(1.09-2.45) and MROP (2.96(2.10-4.16), with greater increase in MROP observed.
CONCLUSIONS:
This study confirms the upward trend in both BMI and the incidence of PPH and MROP in healthy childbearing women. No evidence was identified linking the rise in BMI to the ongoing increase in PPH and MROP.
KEY MESSAGE:
Critically evaluate third stage management, as overtreatment may contribute to rising PPH and MROP rates. Emphasize watchful attendance (9) and inform women about the protective effect of home birth. Poster session 1 (Group A)
| eISSN: | 2585-2906 |
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