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Maternal obesity and postpartum haemorrhage after vaginal and caesarean delivery among nulliparous women at term: a retrospective cohort study

Overview of attention for article published in BMC Pregnancy and Childbirth, October 2012
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Title
Maternal obesity and postpartum haemorrhage after vaginal and caesarean delivery among nulliparous women at term: a retrospective cohort study
Published in
BMC Pregnancy and Childbirth, October 2012
DOI 10.1186/1471-2393-12-112
Pubmed ID
Authors

Elaine M Fyfe, John MD Thompson, Ngaire H Anderson, Katie M Groom, Lesley M McCowan

Abstract

Increasing rates of postpartum haemorrhage in developed countries over the past two decades are not explained by corresponding changes in risk factors and conjecture has been raised that maternal obesity may be responsible. Few studies investigating risk factors for PPH have included BMI or investigated PPH risk among nulliparous women. The aim of this study was to determine in a cohort of nulliparous women delivering at term whether overweight and obesity are independent risk factors for major postpartum haemorrhage (PPH ≥1000ml) after vaginal and caesarean section delivery. The study population was nulliparous singleton pregnancies delivered at term at National Women's Hospital, Auckland, New Zealand from 2006 to 2009 (N=11,363). Multivariable logistic regression was adjusted for risk factors for major PPH. There were 7238 (63.7%) women of normal BMI, 2631 (23.2%) overweight and 1494 (13.1%) obese. Overall, PPH rates were increased in overweight and obese compared with normal-weight women (n=255 [9.7%], n=233 [15.6%]), n=524 [7.2%], p <.001) respectively. There was an approximate twofold increase in risk in obese nulliparous women that was independent of confounders, adjusted odds ratio [aOR (95% CI)] for all deliveries 1.86 (1.51-2.28). Being obese was a risk factor for major PPH following both caesarean 1.73 (1.32-2.28) and vaginal delivery 2.11 (1.54-2.89) and the latter risk was similar after exclusion of women with major perineal trauma and retained placentae. Three additional factors were consistently associated with risk for major PPH regardless of mode of delivery: increasing infant birthweight, antepartum haemorrhage and Asian ethnicity. Nulliparous obese women have a twofold increase in risk of major PPH compared to women with normal BMI regardless of mode of delivery. Higher rates of PPH among obese women are not attributable to their higher rates of caesarean delivery. Obesity is an important high risk factor for PPH, and the risk following vaginal delivery is emphasised. We recommend in addition to standard practice of active management of third stage of labour, there should be increased vigilance and preparation for PPH management in obese women.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 174 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Brazil 2 1%
Canada 1 <1%
France 1 <1%
Unknown 170 98%

Demographic breakdown

Readers by professional status Count As %
Student > Master 30 17%
Student > Bachelor 30 17%
Researcher 15 9%
Student > Postgraduate 14 8%
Student > Doctoral Student 11 6%
Other 33 19%
Unknown 41 24%
Readers by discipline Count As %
Medicine and Dentistry 72 41%
Nursing and Health Professions 21 12%
Social Sciences 7 4%
Agricultural and Biological Sciences 6 3%
Biochemistry, Genetics and Molecular Biology 6 3%
Other 18 10%
Unknown 44 25%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 26 October 2012.
All research outputs
#14,638,545
of 23,881,329 outputs
Outputs from BMC Pregnancy and Childbirth
#2,742
of 4,379 outputs
Outputs of similar age
#101,429
of 177,804 outputs
Outputs of similar age from BMC Pregnancy and Childbirth
#28
of 46 outputs
Altmetric has tracked 23,881,329 research outputs across all sources so far. This one is in the 37th percentile – i.e., 37% of other outputs scored the same or lower than it.
So far Altmetric has tracked 4,379 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 9.0. This one is in the 35th percentile – i.e., 35% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 177,804 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 42nd percentile – i.e., 42% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 46 others from the same source and published within six weeks on either side of this one. This one is in the 39th percentile – i.e., 39% of its contemporaries scored the same or lower than it.