by Jared Reed  

A study has confirmed the widely held belief that pregnant women are more likely to experience nosebleeds, and also linked epistaxis to an increased risk of postpartum haemorrhage.  

A cohort study of almost 1500 pregnant women found that at least one in five women experienced two or more nosebleeds during pregnancy, compared to a rate of 6% in the general population. Gingival bleeding was also more common during pregnancy.  

The study, published in Obstetrics and Gynaecology (114; 6: 1322-25) this month, also showed that a history of epistaxis during pregnancy was associated with a greater risk for postpartum haemorrhage (10.7% vs 6.2%) compared to women without epistaxis, even after controlling for caesarean section delivery and a history of epistaxis before pregnancy.  

The researchers from Chicago’s Northwestern University hypothesised that pregnancy-related epistaxis was due to oestrogen-induced nasal congestion and mucosal oedema, as well as to increased rhinitis during pregnancy.  

However they say that increased epistaxis in pregnant women may also be due to changes in haemostatis or abnormalities in vessel integrity or structure that also predisposes to postpartum haemorrhage.  

Given the results, obstetricians may be able to better prepare for postpartum haemorrhage by obtaining preoperative blood bank specimens and having uterotonics available in the delivery room, the authors suggest.  

“As in the non-pregnant population, eliciting [a history of epistaxis] may help to identify women at risk for disordered haemostatis,” they conclude.