Skip to main content

Advertisement

SpringerLink
Log in

Trend Changes in the individual contribution of risk factors for postpartum hemorrhage over more than two decades

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Objective

Postpartum hemorrhage is an obstetric emergency with a rising incidence. The aim of this study was to identify trends in the specific contribution of various risk factors for postpartum hemorrhage by observing their odds ratios throughout different time periods.

Study design

In this population-based retrospective cohort study trends of change in odds ratios for known risk factors for postpartum hemorrhage occurring in three consecutive eight-year intervals between 1988 and 2014 were compared. Two multivariable logistic regression models were used in order to identify independent risk factors for postpartum hemorrhage in our population. Trends of various risk factors were compared along the time period of the study.

Results

The incidence of postpartum hemorrhage increased from 0.5% to 1988 to 0.6%. Using logistic regression models, preeclampsia, vacuum extraction delivery, retained placenta, perineal or vaginal tears and delivery of a large for gestational age neonate were recognized as independent risk factors for postpartum hemorrhage. While the odds ratios for perineal or vaginal tears significantly increased, odds ratios for delivery of a large for gestational age neonate significantly decreased. Odds ratios for the other risk factors did not change significantly.

Conclusion

In our study, not only did the rates of statistically significant risk factors for postpartum hemorrhage change during the study period, the specific contribution of each risk factor changed as well. Having a better understanding of these trends might augment our ability to predict this grave obstetric complication and improve maternal outcomes in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Availability of data and material

Not applicable.

Code Availability

Not applicable.

References

  • Abdul-Kadir, R., McLintock, C., Ducloy, A. S., El-Refaey, H., England, A., Federici, A. B., Grotegut, C. A., Halimeh, S., Herman, J. H., Hofer, S., James, A. H., Kouides, P. A., Paides, M. J., Peyvandi, F., & Winikoff, R. (2014). Evaluation and management of postpartum hemorrhage: consensus from an international expert panel. Transfusion, 54, 1756–1768. https://doi.org/10.1111/trf.12550

    Article  PubMed  Google Scholar 

  • Ananth, C. V., Keyes, K. M., Hamilton, A., Gissler, M., Wu, C., Liu, S., Luque-Fernandez, M. A., Skjærven, R., Williams, M. A., Tikkanen, M., & Cnattingius, S. (2015). An international contrast of rates of placental abruption: an age-period-cohort analysis. Plos One, 10:e0125246.https://doi.org/10.1371/journal.pone.0125246

  • Ananth, C. V., Duzyi, C. M., Yadava, S., Schwebel, M., Tita, A. T. N., & Joseph, K. S. (2019). Changes in the prevalence of chronic hypertension in pregnancy, United States, 1970 to 2010. Hypertension, 74, 1089–1095. https://doi.org/10.1161/HYPERTENSIONAHA.119.12968

    Article  CAS  PubMed  Google Scholar 

  • Auger, N., Luo, Z. C., Nuyt, A. M., Kaufman, J. S., Naimi, A. I., Platt, R. W., & Fraser, W. D. (2016). Secular trends in preeclamsia incidence and outcomes in a large Canada database: a longitudinal study over 24 years. Can J Cardiol, 32:987.e15-23.https://doi.org/10.1016/j.cjca.2015.12.011

  • Bateman, B. T., Berman, M. F., Riley, L. E., & Leffert, L. R. (2010). The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth analg, 110, 1368–1373. https://doi.org/10.1213/ANE.0b013e3181d74898

    Article  PubMed  Google Scholar 

  • Callaghan, W. M., Kuklina, E. V., & Berg, C. J. (2010). Trends in postpartum hemorrhage: United- States, 1994–2006. Am J Obstet Gynecol, 202:353.e1-6.https://doi.org/10.1016/j.ajog.2010.01.011

  • Committee on practice bulletins-obstetrics. Practice bulletin no. 183: postpartum hemorrhage (2017). Obstet Gynecol, 130:e168-e186.https://doi.org/10.1097/AOG.0000000000002351

  • Joseph, K. S., Rouleau, J., Kramer, M. S., Young, D. C., Liston, R. M., & Baskett, T. F. (2007). Investigation of an increase in postpartum haemorrhage in Canada. Bjog, 114, 751–759. https://doi.org/10.1111/j.1471-0528.2007.01316.x

    Article  CAS  PubMed  Google Scholar 

  • Kashanian, S., Dadkhah, F., Tabatabaei, N., & SheikHansari, N. (2021). Effects of tranexamic acid on the amount of bleeding following vaginal delivery and its adverse effects: a double-blind placebo controlled randomized clinical trial. J Matern Neonatal Fetal Med. 23;1–5. https://doi:10.1080/14767058.2021.1888911

  • Kc, K., Shakya, S., & Zhang, H. (2015). Gestational diabetes mellitus and macrosomia: a literature review. Ann nutr metab, 66 suppl 2:14–20. https://doi.org/10.1159/000371628.Kramer, M. S., Berg, C., Abenhaim, H., Dahhou, M., Rouleau, J., Mehrabadi, A., & Joseph, K. S. (2013). Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol, 209:449.e1-7. https://doi.org/10.1016/j.ajog.2013.07.007

  • Marshall, A. L., Durani, U., Bartley, A., Hagen, C. E., Ashrani, A., Rose, C., Go, R. S., & Pruthi, R. (2017). K. The impact of postpartum hemorrhage on hospital length of stay and inpatient mortality: a national inpatient sample-based analysis. Am J Obstet Gynecol, 217:344.el-344.e6. https://doi.org/10.1016/j.ajog.2017.05.004

  • Mhyre, J. M., Shilkrut, A., Kuklina, E. V., Callaghan, W. M., Creanga, A. A., Kaminsky, S., & Bateman, B. T. (2013). Massive blood transfusion during hospitalization for delivery in New York state, 1998–2007. Obstetrics And Gynecology, 122, 1988–1994. https://doi.org/10.1097/AOG.0000000000000021

    Article  Google Scholar 

  • Ornoy, A. (2011). Prenatal origin of obesity and their complications: gestational diabetes, maternal overweight and paradoxical effects of fetal growth restriction and macrosomia. Reprod Toxicol, 32:205 – 12.https://doi.org/10.1016/j.reprotox.2011.05.002

  • Sharp, G. C., Saunders, P. T., Greene, S. A., Morris, A. D., & Norman, J. E. (2014). Intergenerational transmission of postpartum hemorrhage risk: analysis of 2 Scottish birth cohorts. Am J Obstet gynecol, 211:51.e1-7.https://doi.org/10.1016/j.ajog.2014.01.012

  • Sheiner, E., Sarid, L., Levy, A., Seidman, D. S., & Hallak, M. (2005). Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population- based study. J Matern Fetal Neonatal Med, 18:149 – 54. https://doi.org/10.1080/14767050500170088

  • WOMAN trial collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomized, double-blind, placebo-controlled trial (2017). Lancet, 389:2105–2116.https://doi.org/10.1016/S0140-6736(17)30638-4

  • Wetta, L. A., Szychowski, J. M., Seals, S., Mancuso, M. S., Biggio, J. R., & Tita, A. T. N. (2013). Risk factors for uterine atony/postpartum hemorrhage requiring treatment after vaginal delivery. Am J Obstet Gynecol, 209:51.e1-6.https://doi.org/10.1016/j.ajog.2013.03.011

  • You, S. H., Cheng, P. J., Chung, T. T., Kuo, C. F., Wu, H. M., & Chu, P. H. (2018). Population-based trends and risk factors of early- and late-onset preeclampsia in Taiwan 2001–2014. Bmc Pregnancy And Childbirth, 18, 199

    Article  Google Scholar 

Download references

Funding

This study was not funded.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, PO Box 151, Beer-Sheva, Israel

    Shanny Sade, Adi Y. Weintraub, Yael Baumfeld, Dvora Kluwgant, David Yohay & Gali Pariente

  2. Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School of Jerusalem, Jerusalem, Israel

    Reut Rotem

Authors
  1. Shanny Sade
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adi Y. Weintraub
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yael Baumfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dvora Kluwgant
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Yohay
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Reut Rotem
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gali Pariente
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

S Sade: Data collection, Data management, manuscript writing. AY Weintraub: Project development, Data management, Manuscript editing. Y Baumfeld: Data analysis. D Kluwgant: Manuscript editing. D Yohay: Project development. R Rotem: Data analysis. G Pariente: Project development, Data management, Manuscript edit.

Corresponding author

Correspondence to Shanny Sade.

Ethics declarations

Conflict of interest/competing interest

The authors declare that they have no conflict of interest.

Ethics approval

Ethical approval was waived by the local Ethics Committee of University A in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sade, S., Weintraub, A.Y., Baumfeld, Y. et al. Trend Changes in the individual contribution of risk factors for postpartum hemorrhage over more than two decades. Matern Child Health J 26, 2228–2236 (2022). https://doi.org/10.1007/s10995-022-03461-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-022-03461-y

Keywords

Search

Navigation