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Predictors of severity in primary postpartum hemorrhage

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To identify risk factors and etiologies leading to severe primary postpartum hemorrhage (PPH) in women with PPH.

Methods

Women who experienced PPH within the first 24 h after delivery over a 3-year period were retrospectively evaluated. Patients were divided into two groups on the basis of severe PPH (n = 125) or non-severe PPH (n = 411). Risk factors and etiologies for severe PPH were explored using univariate and multivariate logistic regression analyses.

Results

PPH and severe PPH complicated 2.1 and 0.49 % of all deliveries, respectively. Previous cesarean delivery (OR = 3.15, 95 % CI = 1.02–10.3; p = 0.001), prolonged labor (OR = 3.62, 95 % CI = 3.21–4.03; p < 0.001), oxytocin augmentation (OR = 3.32, 95 % CI 2.05–5.93; p < 0.001) and emergency cesarean delivery (OR = 4.75, 95 % CI 1.32–12.96; p < 0.001) were the factors independently associated with severe PPH. Etiologies significantly associated with severe PPH are uterine atony (OR = 2.72, 95 % CI 1.64–4.55; p < 0.001) and abnormal placentation (OR = 3.05, 95 % CI 1.56–6.27; p = 0.006).

Conclusion

Previous cesarean delivery, prolonged labor, oxytocin augmentation and emergency cesarean delivery are strongest predictors of severe blood loss in women with PPH. In addition, uterine atony and abnormal placentation are the etiologies significantly associated with severe PPH.

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References

  1. American College of Obstetricians and Gynecologists (2006) ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 76, october 2006: postpartum hemorrhage. Obstet Gynecol 108:1039–1047

    Article  Google Scholar 

  2. Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B (2008) Prevalence and risk factors of severe obstetric haemorrhage. BJOG 115:1265–1272

    Article  CAS  PubMed  Google Scholar 

  3. James AH, Paglia MJ, Gernsheimer T, Grotegut C, Thames B (2009) Blood component therapy in postpartum hemorrhage. Transfusion 49:2430–2433

    Article  PubMed  Google Scholar 

  4. McLintock C, James AH (2011) Obstetric hemorrhage. J Thromb Haemost 9:1441–1451

    Article  CAS  PubMed  Google Scholar 

  5. Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle MH, Ford JB et al (2009) Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth 9:55

    Article  PubMed Central  PubMed  Google Scholar 

  6. Combs CA, Murphy EL, Laros RK Jr (1991) Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol 77:69–76

    CAS  PubMed  Google Scholar 

  7. Kramer MS, Dahhou M, Vallerand D, Liston R, Joseph KS (2011) Risk factors for postpartum hemorrhage: can we explain the recent temporal increase? J Obstet Gynaecol Can 33:810–819

    PubMed  Google Scholar 

  8. Combs CA, Murphy EL, Laros RK Jr (1991) Factors associated with hemorrhage in cesarean deliveries. Obstet Gynecol 77:77–82

    CAS  PubMed  Google Scholar 

  9. Health Canada (2004) Special report on maternal mortality and severe morbidity in Canada—enhanced surveillance: the path to prevention. Minister of Public Works and Government Sevices, Ottawa, Canada, pp 1–36

  10. Cortet M, Maucort-Boulch D, Deneux-Tharaux C, Dupont C, Rudigoz RC, Roy P et al (2014) Severity of post-partum hemorrhage after vaginal delivery is not predictable from clinical variables available at the time post-partum hemorrhage is diagnosed. J Obstet Gynaecol Res. doi:10.1111/jog.12528

    PubMed  Google Scholar 

  11. Benedetti J (1991) Obstetric Hemorrhage. In: Clark SL, Cotton DB, Hankins GDV, Phelan JP (eds) Critical Care Obstetrics, 2nd edn. Blackwell Scientific, Boston, pp 73–606

    Google Scholar 

  12. Cohen WR, Friedman EA (2014) Perils of the new labor management guidelines. Am J Obstet Gynecol. doi:10.1016/j.ajog.2014.09.008

    PubMed Central  Google Scholar 

  13. Bauer ST, Bonanno C (2009) Abnormal placentation. Semin Perinatol 33:88–96

    Article  PubMed  Google Scholar 

  14. Bateman BT, Berman MF, Riley LE, Leffert LR (2010) The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg 110:1368–1373

    Article  PubMed  Google Scholar 

  15. Montufar-Rueda C, Rodriguez L, Jarquin JD, Barboza A, Bustillo MC, Marin F et al (2013) Severe postpartum hemorrhage from uterine atony: a multicentric study. J Pregnancy 2013:525914

    Article  PubMed Central  PubMed  Google Scholar 

  16. Driessen M, Bouvier-Colle MH, Dupont C, Khosnood B, Rudigoz RC, Deneux-Tharaux C, Pithagore6 Group (2011) Postpartum hemorrhage resulting from uterine atony after vaginal delivery: factors associated with severity. Obstet Gynecol 117:21–31

    Article  PubMed Central  PubMed  Google Scholar 

  17. Bohlmann MK, Rath W (2014) Medical prevention and treatment of postpartum hemorrhage: a comparison of different guidelines. Arch Gynecol Obstet 289:555–567

    Article  PubMed  Google Scholar 

  18. Grotegut CA, Paglia MJ, Johnson LN, Thames B, James AH (2011) Oxytocin exposure during labor among women with postpartum hemorrhage secondary to uterine atony. Am J Obstet Gynecol 204:56e1–56e6

    Article  Google Scholar 

  19. Belghiti J, Kayem G, Dupont C, Rudigoz RC, Bouvier-Colle MH, Deneux-Tharaux C (2011) Oxytocin during labour and risk of severe postpartum hemorrhage: a population-based, cohort-nested case-control study. BMJ Open 1:e000514

    Article  PubMed Central  PubMed  Google Scholar 

  20. Mehrabadi A, Hutcheon JA, Lee L, Liston RM, Joseph KS (2012) Trends in postpartum hemorrhage from 2000 to 2009: a population based study. BMC Pregnancy Childbirth 12:108

    Article  PubMed Central  PubMed  Google Scholar 

  21. Knight M; UKOSS (2007) Peripartum hysterectomy in the UK: management and outcomes of the associated hemorrhage. BJOG 114:1380–1387

    Article  Google Scholar 

  22. Sahin S, Guzin K, Eroğlu M, Kayabasoglu F, Yaşartekin MS (2014) Emergency peripartum hysterectomy: our 12-year experience. Arch Gynecol Obstet 289:953–958

    Article  PubMed  Google Scholar 

  23. Allam IS, Gomaa IA, Fathi HM, Sukkar GF (2014) Incidence of emergency peripartum hysterectomy in Ain-shams University Maternity Hospital, Egypt: a retrospective study. Arch Gynecol Obstet 290:891–896

    Article  PubMed  Google Scholar 

  24. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA et al (2006) Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 107:1226–1232

    Article  PubMed  Google Scholar 

  25. Chantraine F, Braun T, Gonser M, Henrich W, Tutschek B (2013) Prenatal diagnosis of abnormally invasive placenta reduces maternal peripartum hemorrhage and morbidity. Acta Obstet Gynecol Scand 92:439–444

    Article  PubMed  Google Scholar 

  26. Anderson JM, Etches D (2007) Prevention and management of postpartum hemorrhage. Am Fam Physician 75:875–882

    PubMed  Google Scholar 

  27. Häger RM, Daltveit AK, Hofoss D, Nilsen ST, Kolaas T, Øian P (2004) Complications of cesarean deliveries: rates and risk factors. Am J Obstet Gynecol 190:428–434

    Article  PubMed  Google Scholar 

  28. Duthie SJ, Ven D, Yung GLK, Guang DZ, Chan SYW, Ma HK (1990) Discrepancy between laboratory determination and visual estimation of blood loss during normal delivery. Eur J Obstet Gynecol Reprod Biol 38:118–124

    Google Scholar 

  29. Stafford I, Dildy GA, Clark SL, Belfort MA (2008) Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol 199:519e1–519e7

    Article  Google Scholar 

  30. Newton M, Mosey IM, Egli GE, Gifford WB, Hull CT (1961) Blood loss during and immediately after delivery. Obstet Gynecol 94:711–716

    Google Scholar 

  31. Razvi K, Chua S, Arulkumaran S, Ratnam SS (1996) A comparison between visual estimation and laboratory determination of blood loss during the third stage of labour. Aust N Z J Obstet Gynaecol 36:152–154

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey

    Atalay Ekin, Cenk Gezer, Ulas Solmaz, Cuneyt Eftal Taner, Askin Dogan & Mehmet Ozeren

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  1. Atalay Ekin
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  2. Cenk Gezer
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  3. Ulas Solmaz
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  5. Askin Dogan
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Correspondence to Atalay Ekin.

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Ekin, A., Gezer, C., Solmaz, U. et al. Predictors of severity in primary postpartum hemorrhage. Arch Gynecol Obstet 292, 1247–1254 (2015). https://doi.org/10.1007/s00404-015-3771-5

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  • DOI: https://doi.org/10.1007/s00404-015-3771-5

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