Abstract
Severe postpartum haemorrhages (PPH)a re responsible for maternal morbidity/mortality.T heir complexm anagement sometimesr equires haemostatics upplementation, and therapeutic trials on fibrinogen or activated factorVII, which mayadd to the thrombotic risk, arec urrentlyb eing considered.F urthermore, there is ar isko fv enous thromboembolism (VTE) during the postpartum period, hence we studied the relationship between severe PPH andVTE in womend uring their first pregnancy. Among the32,463 womenenrolled between January 1,1999 and February1,2004 in the NOHA Firstcohort, 317developed severe PPH,11postpartumVTE and 60 had postpartum superficialv eint hrombosis (SVT). In the womenw ith severe PPH,whilstt here were no episodes of VTE,there were three episodes of SVT, which occurred6weeks postpartum.All of the
womenwith severe PPH received packedred blood cell (RBC) units,29( 9.1%)p latelets units,51( 16.1%)f resh frozen plasma and29(9.1%)fibrinogen concentrates.Threepatientswith both severe PPH andSVT received onlypacked RBC. Severe PPH or packedRBC unittransfusion were associated with postpartum SVT (adjusted relativer isk: 5.3 (1.6-17) and 4.7 (1.5-15) respectively),independent of caesareansection deliveryand lowmolecular-weight heparin (LMWH) usei nt he postpartum,but were not independent indicators of onea nother. This the VTE and SVTr isks associated with severe PPH arel ow (<1% and <2%, respectively).SeverePPH increasesthe risk of postpartum SVT,but transfusionwith plateletunits and plasma supplementationusing freshfrozen plasma or fibrinogenconcentrates do not markedlymodulatethe risk of venous thrombosis.