Does chronic low molecular weight heparins use during pregnancy increase the risk of postpartum hemorrhage?

Published:December 17, 2022DOI:
      Postpartum hemorrhage (PPH) continues to be the leading preventable cause of maternal morbidity and mortality worldwide. Although many risk factors have been identified, this life-threatening complication often occurs in women who have no clear identifiable risk factors [
      • Kramer M.S.
      • Berg C.
      • Abenhaim H.
      • Dahhou M.
      • Rouleau J.
      • Mehrabadi A.
      • Joseph K.S.
      Incidence, risk factors, and temporal trends in severe postpartum hemorrhage.


      ART (assisted reproductive technologies), BMI (body mass index), CI (confidence interval), CS (caesarean section), IQR (interquartile range), LMWHs (low-molecular-weight heparins), PPH (postpartum hemorrhage), RR (relative risk), VTE (venous thrombo-embolism), WHO (World Health Organization), aRR (adjusted relative risk)


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        • Kramer M.S.
        • Berg C.
        • Abenhaim H.
        • Dahhou M.
        • Rouleau J.
        • Mehrabadi A.
        • Joseph K.S.
        Incidence, risk factors, and temporal trends in severe postpartum hemorrhage.
        Am. J. Obstet. Gynecol. 2013 Nov; 209: 449.e1-449.e7
        • Zullino S.
        • Clemenza S.
        • Mecacci F.
        • Petraglia F.
        Low molecular weight heparins (LMWH) and implications along pregnancy: a focus on the placenta.
        Reprod. Sci. 2021 Jul 6;
        • Sirico A.
        • Saccone G.
        • Maruotti G.M.
        • Grandone E.
        • Sarno L.
        • Berghella V.
        • Zullo F.
        • Martinelli P.
        Low molecular weight heparin use during pregnancy and risk of postpartum hemorrhage: a systematic review and meta-analysis.
        J. Matern. Fetal Neonatal Med. 2019 Jun; 32: 1893-1900
        • Knol H.M.
        • Schultinge L.
        • Veeger N.J.
        • Kluin-Nelemans H.C.
        • Erwich J.J.
        • Meijer K.
        The risk of postpartum hemorrhage in women using high dose of low-molecular-weight heparins during pregnancy.
        Thromb. Res. 2012 Sep; 130: 334-338
        • Wang E.H.
        • Marnoch C.A.
        • Khurana R.
        • Sia W.
        • Yuksel N.
        Haemorrhagic complications of peripartum anticoagulation: a retrospective chart review.
        Obstet. Med. 2014 Jun; 7: 77-83
        • Maslovitz S.
        • Many A.
        • Landsberg J.A.
        • Varon D.
        • Lessing J.B.
        • Kupferminc M.J.
        The safety of low molecular weight heparin therapy during labor.
        J. Matern. Fetal Neonatal Med. 2005 Jan; 17: 39-43
        • Kominiarek M.A.
        • Angelopoulos S.M.
        • Shapiro N.L.
        • Studee L.
        • Nutescu E.A.
        • Hibbard J.U.
        Low-molecular-weight heparin in pregnancy: peripartum bleeding complications.
        J. Perinatol. 2007 Jun; 27: 329-334
        • Freedman R.A.
        • Bauer K.A.
        • Neuberg D.S.
        • Zwicker J.I.
        Timing of postpartum enoxaparin administration and severe postpartum hemorrhage.
        Blood Coagul. Fibrinolysis. 2008 Jan; 19: 55-59
        • Arbuthnot C.
        • Browne R.
        • Nicole S.
        • Erb S.J.
        • Farrall L.
        • Borg A.
        A double centre retrospective study into rates of postpartum haemorrhage in women on low molecular weight heparin.
        Br. J. Haematol. 2017 Jan; 176: 141-143
        • Roshani S.
        • Cohn D.M.
        • Stehouwer A.C.
        • Wolf H.
        • van der Post J.A.
        • Büller H.R.
        • Kamphuisen P.W.
        • Middeldorp S.
        Incidence of postpartum haemorrhage in women receiving therapeutic doses of low-molecular-weight heparin: results of a retrospective cohort study.
        BMJ Open. 2011 Nov 14; 1e000257
        • Omotayo M.O.
        • Abioye A.I.
        • Kuyebi M.
        • Eke A.C.
        Prenatal anemia and postpartum hemorrhage risk: a systematic review and meta-analysis.
        J. Obstet. Gynaecol. Res. 2021 Aug; 47: 2565-2576
        • Adebiyi A.
        • Adaikan G.P.
        • Prasad R.N.
        Oxytocic activity of thrombin: modulation of thrombin-induced gravid rat myometrial contractions by 5-hydroxytryptamine receptor antagonists.
        J. Perinat. Med. 2004; 32: 126-131
        • Elovitz M.A.
        • Saunders T.
        • Ascher-Landsberg J.
        • Phillippe M.
        Effects of thrombin on myometrial contractions in vitro and in vivo.
        Am. J. Obstet. Gynecol. 2000 Oct; 183: 799-804
        • Nishimura F.
        • Mogami H.
        • Moriuchi K.
        • Chigusa Y.
        • Mandai M.
        • Kondoh E.
        Mechanisms of thrombin-induced myometrial contractions: potential targets of progesterone.
        PLoS One. 2020 May 4; 15e0231944
        • McLean K.C.
        • Bernstein I.M.
        • Brummel-Ziedins K.E.
        Tissue factor-dependent thrombin generation across pregnancy.
        Am. J. Obstet. Gynecol. 2012 Aug; 207: 135.e1-135.e6