Predictive analysis of maternal subcutaneous fat thickness for the risk of postpartum haemorrhage

The incidence of postpartum haemorrhage has been increasing in several developed countries over the past two decades. Obese women are at increased risk of postpartum hemorrhage. Till date BMI has been used to define obesity. Maternal abdominal subcutaneous fat thickness (SCFT) can be used as a measure for central obesity and can be measured by ultrasound easily. The present study was done to find association between maternal BMI and SCFT with development of PPH and to find a cut-off value of BMI and SCFT for prediction of risk of PPH.
Methods: 200 women with live singleton pregnancy of 16-18 weeks gestation were included in the study after obtaining written informed consent. Maternal abdominal subcutaneous thickness was measured by USG. All women were monitored till delivery and observed for PPH. All data were entered into MS excel sheet and analysed.
Results: Mean BMI was significantly more in women who had PPH (25.85 ± 3.24 vs 22.63 ± 2.80 kg/m2, p - <0.001).  Mean SCFT was significantly more in women who had PPH than in women without PPH (16.12 ± 2.75 vs 12.22 ± 3.00 mm, p - <0.001). On ROC curve analysis, SCFT above 15.7 mm (AUC=0.840) predicted PPH with a sensitivity of 85% and specificity of 86% and associated with approximately 34 times increased risk of PPH [OR 34.1; 95% CI ((7.1383 – 162.49290, p - <0.0001].
Conclusion: Maternal abdominal subcutaneous fat thickness measured at 16 to 18 weeks of pregnancy by USG is a reliable marker to identify women at risk of PPH.