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

Objective: To assess risk markers for short-term major adverse cardiovascular events (MACE) following postpartum haemorrhage (PPH). 

Design: A retrospective cohort study. Setting: Five study sites across the US, Canada, the Netherlands and Colombia. 

Population: Individuals with PPH in 2012–2017. 

Main Outcome Measures: MACE (including acute myocardial infarction, pulmonary oedema, cardiomyopathy, stroke, and cardiac death) observed during a hospitalisation for birth. 

Methods: We compared characteristics and therapeutic interventions (as indicators of severe bleeding) among participants with and without MACE. We conducted an exploratory analysis using multivariable logistic regression to identify risk markers for MACE. 

Results: Two thousand and sixty-nine participants had PPH (US: n = 1055, Canada: n = 613, the Netherlands: n = 302, Colombia: n = 99), of whom 40 (1.93%, 95% CI [1.38, 2.62]) experienced MACE. Pulmonary oedema was the most common type of event (n = 37, 1.79%, 95% CI [1.26–2.46]). Participants with MACE had more preeclampsia (30% vs. 9.91%) and heart disease (7.50% vs. 1.38%) than those without (p < 0.05). MACE occurred more frequently in the context of infections (adjusted odds ratio [aOR] 6.81, 95% CI [3.24–14.33]), aspirin use (aOR 4.49, 95% CI [1.07–18.85]), and markers of severe bleeding, such as the need for prostaglandin F2 alpha analogues (aOR 3.16, 95% CI [1.41–7.07]) and blood products (aOR 3.08, 95% CI [1.41–6.71]). A higher antenatal haemoglobin was associated with less MACE (aOR 0.96, 95% CI [0.94–0.98]). 

Conclusion: About 2 in 100 persons with PPH developed MACE, mostly pulmonary oedema. Risk markers identified individuals with PPH who may require increased monitoring. Whether treating anaemia can prevent cardiovascular morbidity following PPH must be evaluated.