CoChat
Sign Up
Cited by 80Maternal and fetal healthcareIron Metabolism and DisordersMaternal and Perinatal Health Interventions

Patterns and predictors of severe postpartum anemia after C esarean section

Open access
Butwick, Alexander J., Walsh, Eileen M., Kuzniewicz, Michael, Li, Sherian X., Escobar, Gabriel J.·2017·Transfusion
DOI 10.1111/trf.13815PMC PMC5243180
Open this paper in CoChat — free account

Abstract

BACKGROUND: Postpartum anemia is associated with maternal and perinatal morbidity. Population‐level data may inform guideline development for postpartum anemia screening. Our objectives were to evaluate the associations between potential predictors (predelivery anemia and postpartum hemorrhage [PPH]) with severe postpartum anemia after Cesarean section. STUDY DESIGN AND METHODS: Data were collected from 70,939 hospitalizations for Cesarean section performed at Kaiser Permanente Northern California facilities between 2005 and 2013. Severe postpartum anemia was defined as a hemoglobin (Hb) level of less than 8 g/dL before hospital discharge. Using multivariable logistic regression, we assessed the associations between predelivery anemia and PPH with severe postpartum anemia. Distributions of these characteristics among women with severe postpartum anemia were evaluated. RESULTS: The overall rate of severe postpartum anemia was 7.3% (95% confidence interval [CI], 7.1%‐7.4%). Severe postpartum anemia was strongly associated with a predelivery Hb level between 10 and 10.9 g/dL (adjusted odds ratio [aOR], 5.4; 95% CI, 4.89‐5.91), predelivery Hb level of less than 10 g/dL (aOR, 30.6; 95% CI, 27.21‐34.6), and PPH (aOR, 8.45; 95% CI, 7.8‐9.16). The proportions of women with severe postpartum anemia were highest for those experiencing PPH but no predelivery anemia (12.2%; 95% CI, 11.0%‐13.6%) and those who did not incur PPH nor predelivery anemia (10.7%; 95% CI, 9.6%‐12.0%). CONCLUSIONS: Our findings suggest that PPH and predelivery anemia are strong independent risk factors for severe postpartum anemia. Optimization of patients' Hb before delivery may reduce the incidence of severe anemia after Cesarean section.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1111/trf.13815

Cites

40 of 40 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Preoperative anemia has been shown to increase the perioperative morbidity and mortality rates, and postpartum anemia itself can affect recovery.

    “Furthermore, preoperative anemia has been shown to increase the perioperative morbidity and mortality rates, and postpartum anemia itself can affect recovery.61,62”

    From Guidelines for antenatal and preoperative care in cesarean delivery: Enhanced Recovery After Surgery Society recommendations (part 1)—2025 update (2026) · cites this paper as [62]

    The Introduction (page unavailable) links postpartum anemia to depression, fatigue and impaired cognition, supporting the claim that it can affect recovery. The Discussion (page unavailable) identifies predelivery anemia as a risk factor for severe postpartum anemia after cesarean section, but does not say that preoperative anemia increases perioperative morbidity or mortality rates. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Butwick, A. J., Walsh, E. M., Kuzniewicz, M., Li, S. X., & Escobar, G. J.
Affiliations
  • Stanford Medicine (US)
  • Kaiser Permanente (US)
Corresponding author
Butwick, Alexander J.
ORCID
Venue
Transfusion
Publisher
Wiley
Published
2016-09-13
Volume
57
Issue
1
Pages
36-44
ISSN
  • 0041-1132 (ISSN-L)
  • 1537-2995
DOI
10.1111/trf.13815
PMC
PMC5243180
OpenAlex
W2523917024
Semantic Scholar
47e71e97f22c0ee7d2066f37baa060118d657b9d
Cited by
80
References
40
Citations by year
2026: 10 · 2025: 11 · 2024: 10 · 2023: 10 · 2022: 9 · 2021: 9 · 2020: 6 · 2019: 4 · 2018: 8 · 2017: 3
FWCI
5.82
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Transfusion (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
National Institute of Child Health and Human Development (K23HD070972)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Keywords
postpartum anemia, cesarean section, postpartum hemorrhage, hemoglobin levels, risk factors, anemia screening, maternal morbidity
MeSH terms
Adult, Anemia, California, Cesarean Section, Female, Hemoglobins, Postpartum Hemorrhage, Humans, Infant, Newborn, Male, Pregnancy, Pregnancy Complications, Hematologic, Risk Factors

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review