Raised nitric oxide levels may cause atonic postpartum hemorrhage in women with anemia during pregnancy

Abstract Objective To determine the association of hemoglobin (Hb) and plasma nitrite (PN) concentrations on admission to the delivery ward with the occurrence of atonic postpartum hemorrhage (PPH). Methods Of 319 women admitted to the Department of Obstetrics and Gynecology, Dayrout General Hospita...

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Bibliographic Details
Published in:International journal of gynecology and obstetrics 2012-02, Vol.116 (2), p.143-147
Main Authors: Soltan, Mohamed H, Ibrahim, Emad M, Tawfek, Mohammad, Hassan, Hany, Farag, Fady
Format: Article
Language:English
Subjects:
Adolescent
Adult
Anemia - complications
Anemia in pregnancy
Anemias. Hemoglobinopathies
Atonic postpartum hemorrhage
Biological and medical sciences
Diseases of red blood cells
Egypt
Female
Gynecology. Andrology. Obstetrics
Hematologic and hematopoietic diseases
Hemoglobins - metabolism
Humans
Labor, Obstetric
Medical sciences
Middle Aged
Myometrium - metabolism
Nitric oxide
Nitric Oxide - metabolism
Nitrites - blood
Obstetrics and Gynecology
Postpartum Hemorrhage - etiology
Pregnancy
Pregnancy Complications, Hematologic - pathology
Time Factors
Uterine Inertia - etiology
Young Adult
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Summary:Abstract Objective To determine the association of hemoglobin (Hb) and plasma nitrite (PN) concentrations on admission to the delivery ward with the occurrence of atonic postpartum hemorrhage (PPH). Methods Of 319 women admitted to the Department of Obstetrics and Gynecology, Dayrout General Hospital, Assiut, Egypt, for delivery in July 2010, 200, who were not considered to be at risk of atonic PPH, were eligible for inclusion. Plasma levels of Hb and nitrite were measured on admission. The third stage of labor was actively managed. Results A total of 22 participants had significantly raised PN levels ( P < 0.001), 12 of whom developed PPH—with Hb levels of 9 g/dL or less and nitric oxide (NO) levels of 180 μM/L or greater. The other 10 women underwent over 6 hours of stressful labor prior to hospital admission. Conclusion Even moderate anemia can raise levels of NO and enhance its biologic effects, which in turn can result in uterine muscle relaxation and atonic PPH. Preventing or treating anemia during pregnancy could avoid these complications.
ISSN:0020-7292
1879-3479
DOI:10.1016/j.ijgo.2011.09.017