1,489
Views
177
CrossRef citations to date
0
Altmetric
Original

Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: A population-based study

, MD, , , &
Pages 149-154 | Published online: 07 Jul 2009
 

Abstract

Objective. The study was aimed to identify obstetric risk factors for early postpartum hemorrhage (PPH) in singleton gestations and to evaluate pregnancy outcome.

Study design. A comparison between consecutive singleton deliveries with and without early PPH was performed. Deliveries occurred during the years 1988–2002 in a tertiary medical center. A multivariate logistic regression model was constructed in order to define independent risk factors for PPH.

Results. Postpartum hemorrhage complicated 0.4% (n = 666) of all deliveries enrolled in the study (n = 154 311). Significant risk factors for PPH, identified using a multivariable analysis, were: retained placenta (OR 3.5, 95%CI 2.1–5.8), failure to progress during the second stage of labor (OR 3.4, 95%CI 2.4–4.7), placenta accreta (OR 3.3, 95%CI 1.7–6.4), lacerations (OR 2.4, 95%CI 2.0–2.8), instrumental delivery (OR 2.3, 95%CI 1.6–3.4), large for gestational age (LGA) newborn (OR 1.9, 95%CI 1.6–2.4), hypertensive disorders (OR 1.7, 95%CI 1.2–2.1), induction of labor (OR 1.4, 95%CI 1.1–1.7) and augmentation of labor with oxytocin (OR 1.4, 95%CI 1.2–1.7). Women were assigned into three different groups according to the assessed severity of PPH, assuming that the severe cases were handled by revision of the birth canal under anesthesia, and the most severe cases required in addition treatment with blood products. A significant linear association was found between the severity of bleeding and the following factors: vacuum extraction, oxytocin augmentation, hypertensive disorders as well as perinatal mortality, uterine rupture, peripartum hysterectomy and uterine or internal iliac artery ligation (p < 0.001 for all variables).

Conclusion. Hypertensive disorder, failure to progress during the second stage of labor, oxytocin augmentation, vacuum extraction and LGA were found to be major risk factors for severe PPH. Special attention should be given after birth to hypertensive patients, and to patients who underwent induction of labor or instrumental delivery, as well as to those delivering LGA newborns.

Notes

Presented in part at the 25th Annual Scientific Meeting of the Society of Maternal-Fetal Medicine (SMFM), Reno, Nevada, USA, February 2005.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.