Short-Term Major Adverse Cardiovascular Events Following Postpartum Haemorrhage: A Cohort Study (The MACEPH Study)

Area of Science:

• Cardiovascular Medicine
• Obstetrics & Gynecology
• Public Health

Background:

• Postpartum hemorrhage (PPH) is a significant obstetric complication.
• Major adverse cardiovascular events (MACE) following PPH are a concern, but risk factors require further elucidation.

Purpose of the Study:

• To identify risk markers for short-term MACE in individuals experiencing PPH.

Main Methods:

• Retrospective cohort study involving 2,069 participants with PPH across five countries (US, Canada, Netherlands, Colombia) from 2012-2017.
• Exploratory analysis using multivariable logistic regression to identify risk markers for MACE.
• MACE included acute myocardial infarction, pulmonary edema, cardiomyopathy, stroke, and cardiac death during hospitalization for birth.

Main Results:

• 1.93% of participants with PPH experienced MACE, with pulmonary edema being the most common event (1.79%).
• Risk factors for MACE included preeclampsia, pre-existing heart disease, infections, aspirin use, and markers of severe bleeding (e.g., need for prostaglandin F2 alpha analogues, blood products).
• Higher antenatal hemoglobin levels were associated with a reduced risk of MACE.

Conclusions:

• About 2 in 100 individuals with PPH developed MACE, predominantly pulmonary edema.
• Identified risk markers can help pinpoint PPH patients needing closer cardiovascular monitoring.
• Further research is needed to determine if treating anemia can prevent cardiovascular morbidity post-PPH.