Framing postpartum hemorrhage as a consequence of human placental biology: an evolutionary and comparative perspective.

Bibliographic Collection: 
MOCA Reference, APE
Publication Type: Journal Article
Authors: Abrams, Elizabeth T; Rutherford, Julienne N
Year of Publication: 2011
Journal: Am Anthropol
Volume: 113
Issue: 3
Pagination: 417-30
Publication Language: eng
ISSN: 0002-7294
Keywords: Biological Evolution, Embryo Implantation, Female, History, 20th Century, History, 21st Century, Humans, Maternal Mortality, Placentation, Postpartum Hemorrhage, Pregnancy, Trophoblasts, Women's Health

Postpartum hemorrhage (PPH), the leading cause of maternal mortality worldwide, is responsible for 35 percent of maternal deaths. Proximately, PPH results from the failure of the placenta to separate from the uterine wall properly, most often because of impairment of uterine muscle contraction. Despite its prevalence and its well-described clinical manifestations, the ultimate causes of PPH are not known and have not been investigated through an evolutionary lens. We argue that vulnerability to PPH stems from the intensely invasive nature of human placentation. The human placenta causes uterine vessels to undergo transformation to provide the developing fetus with a high plane of maternal resources; the degree of this transformation in humans is extensive. We argue that the particularly invasive nature of the human placenta increases the possibility of increased blood loss at parturition. We review evidence suggesting PPH and other placental disorders represent an evolutionarily novel condition in hominins.

DOI: 10.1111/j.1548-1433.2011.01351.x
Alternate Journal: Am Anthropol