Increased postpartum blood loss in pregnancies associated with placental malaria

Objective: To determine the relationship of placental malaria and parity with postpartum blood loss in a malarious area of Tanzania. Methods: A total of 706 uncomplicated vaginal deliveries were studied at Muhimbili University Hospital, Dares Salaam, Tanzania. Maternal age, parity, date of delivery, birth weight, presence of placental malaria, stillbirths, and delivery complications were noted. Collection and measurement of vaginal blood loss commenced immediately following birth using a plastic vinyl sheet placed underneath the mother. The bed was divided in the middle to allow the blood to drain into a bucket. Blood toss was measured for a period of 2 h following delivery. Results: In singleton births the mean postpartum blood toss was 170 mL in nulliparas and 187 mL in multiparas (p=0.017). Blood toss was 400 mL or greater in 23 women (3.4%) and 500 mL or greater in 10 women (1.5%). Mean postpartum bleeding tended to increase with maternal age, parity, and birth weight. In logistic regression the odds ratio for a blood loss of 400 mL or greater was significantly increased for women with placental malaria (3.2; 95% confidence interval, 1.1-9.0; p=0.028), after adjusting for a birth weight greater than 4000 g. Placental malaria showed a marked seasonal pattern, which corresponded to the months of peak prevalence for a postpartum blood toss of 400 mL or greater (p=0.007). Conclusion: A postpartum blood loss of 400 mL or greater should be considered a possible complication of placental malaria. (c) 2006 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.