Risk factors for severe postpartum hemorrhage: a case-control study

In high-income countries, the incidence of severe postpartum hemorrhage (PPH) has increased. This has important public health relevance because severe PPH is a leading cause of major maternal morbidity. However, few studies have identified risk factors for severe PPH within a contemporary obstetric...

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Bibliographic Details
Published in:BMC pregnancy and childbirth 2017-01, Vol.17 (1), p.17-17, Article 17
Main Authors: Nyfløt, Lill Trine, Sandven, Irene, Stray-Pedersen, Babill, Pettersen, Silje, Al-Zirqi, Iqbal, Rosenberg, Margit, Jacobsen, Anne Flem, Vangen, Siri
Format: Article
Language:English
Subjects:
Adult
Anemia
Anemia - complications
Anticoagulants
Anticoagulants - adverse effects
Birth weight
Births
Blood Transfusion - statistics & numerical data
Blood transfusions
Body mass index
Case-Control Studies
Cesarean section
Childbirth & labor
Cohort Studies
Delivery, Obstetric - adverse effects
Ethnicity
Female
Health risk assessment
Hemorrhage
Humans
In vitro fertilization
Induced labor
Leiomyoma - complications
Logistic Models
Medical records
Norway
Obstetrics
Placenta
Placenta Diseases - etiology
Postpartum Hemorrhage - etiology
Pre-Eclampsia - etiology
Pregnancy
Pregnancy, Multiple
Reproductive Techniques, Assisted - adverse effects
Reproductive technologies
Risk Factors
Uterine Inertia - etiology
Uterine Neoplasms - complications
Womens health
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Summary:In high-income countries, the incidence of severe postpartum hemorrhage (PPH) has increased. This has important public health relevance because severe PPH is a leading cause of major maternal morbidity. However, few studies have identified risk factors for severe PPH within a contemporary obstetric cohort. We performed a case-control study to identify risk factors for severe PPH among a cohort of women who delivered at one of three hospitals in Norway between 2008 and 2011. A case (severe PPH) was classified by an estimated blood loss ≥1500 mL or the need for blood transfusion for excessive postpartum bleeding. Using logistic regression, we applied a pragmatic strategy to identify independent risk factors for severe PPH. Among a total of 43,105 deliveries occurring between 2008 and 2011, we identified 1064 cases and 2059 random controls. The frequency of severe PPH was 2.5% (95% confidence interval (CI): 2.32-2.62). The most common etiologies for severe PPH were uterine atony (60%) and placental complications (36%). The strongest risk factors were a history of severe PPH (adjusted OR (aOR) = 8.97, 95% CI: 5.25-15.33), anticoagulant medication (aOR = 4.79, 95% CI: 2.72-8.41), anemia at booking (aOR = 4.27, 95% CI: 2.79-6.54), severe pre-eclampsia or HELLP syndrome (aOR = 3.03, 95% CI: 1.74-5.27), uterine fibromas (aOR = 2.71, 95% CI: 1.69-4.35), multiple pregnancy (aOR = 2.11, 95% CI: 1.39-3.22) and assisted reproductive technologies (aOR = 1.88, 95% CI: 1.33-2.65). Based on our findings, women with a history of severe PPH are at highest risk of severe PPH. As well as other established clinical risk factors for PPH, a history of severe PPH should be included as a risk factor in the development and validation of prediction models for PPH.
ISSN:1471-2393
1471-2393
DOI:10.1186/s12884-016-1217-0