Title |
Risk factors for severe postpartum hemorrhage: a case-control study
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Published in |
BMC Pregnancy and Childbirth, January 2017
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DOI | 10.1186/s12884-016-1217-0 |
Pubmed ID | |
Authors |
Lill Trine Nyfløt, Irene Sandven, Babill Stray-Pedersen, Silje Pettersen, Iqbal Al-Zirqi, Margit Rosenberg, Anne Flem Jacobsen, Siri Vangen |
Abstract |
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. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 537 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Bachelor | 85 | 16% |
Student > Master | 64 | 12% |
Student > Postgraduate | 46 | 9% |
Researcher | 34 | 6% |
Student > Ph. D. Student | 22 | 4% |
Other | 76 | 14% |
Unknown | 210 | 39% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 176 | 33% |
Nursing and Health Professions | 86 | 16% |
Social Sciences | 8 | 1% |
Agricultural and Biological Sciences | 7 | 1% |
Biochemistry, Genetics and Molecular Biology | 7 | 1% |
Other | 37 | 7% |
Unknown | 216 | 40% |