The influence of prothrombotic polymorphisms and obstetrical and medical variables on the length of secondary postpartum hemorrhage.
OBJECTIVE
To determine if the presence of prothrombotic polymorphisms, such as factor V G1691A (factor V Leiden) or factor II G20210A, affect the length of secondary postpartum bleeding.


METHODS
We conducted a prospective and blind study that enrolled primiparous healthy women following singleton pregnancy. Whole blood was taken for determining the presence of factor V G1691A or prothrombin G20210A by PCR and specific restriction enzymes.


RESULTS
We enrolled 638 women, of whom 524 had vaginal delivery, 34 had planned cesarean delivery, and 80 had emergency cesarean delivery. Seventy-nine of 524 women with vaginal delivery required vacuum, 19 women needed forceps, and 2 women required both vacuum and forceps. Seventy parturients had prothrombotic polymorphisms: 31 were heterozygote to factor V G1691A, 34 were heterozygote to prothrombin G20210A, and 1 was homozygote for the mutation. Another 4 women had both mutations. Women who gave birth by planned cesarean deliveries bled 4.9 days longer on average than women who gave birth vaginally or had emergency cesarean delivery (p = 0.03), after adjustment for length of pregnancy. The weight of the newborn and the length of the pregnancy affected the duration of bleeding. The presence of prothrombotic polymorphisms did not affect the duration of postpartum bleeding.


CONCLUSIONS
The duration of secondary postpartum hemorrhage is related to length of pregnancy, neonate weight, and planned cesarean delivery but is not affected by the presence of factor V G1691A or prothrombin G20210A mutation in the primiparous women.
Salomon
Ophira
O
Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Aviv University, Israel. ophiras@sheba.health.gov.il
Steinberg
David M
DM
Pshithizki
Meirav
M
Zalel
Yaron
Y
Lerner
Asaf
A
Rosenberg
Nurit
N
Achiron
Reuwen
R
D000328:Adult; D001724:Birth Weight; D002585:Cesarean Section / Q000009:adverse effects; D005165:Factor V / Q000235:genetics*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D016133:Polymerase Chain Reaction; D011110:Polymorphism, Genetic; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D049590:Postpartum Period; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D011516:Prothrombin / Q000235:genetics*; D012307:Risk Factors; D016037:Single-Blind Method
C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin