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

BMC Pregnancy and Childbirth

Research Article

Margit Rosenberg¹  Silje Pettersen²  Iqbal Al-Zirqi²  Anne Flem Jacobsen³  Lill Trine Nyfløt⁴  Babill Stray-Pedersen⁵  Siri Vangen⁶  Irene Sandven⁷ 

[1] Department of Gynecology and Obstetrics, Drammen Hospital, P.O.box 800, 3004, Drammen, Norway;Division of Gynecology and Obstetrics, Oslo University Hospital, Rikshospitalet, P.O.box 4950, 0424, Nydalen, Oslo, Norway;Division of Gynecology and Obstetrics, Oslo University Hospital, Rikshospitalet, P.O.box 4950, 0424, Nydalen, Oslo, Norway;Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 1171, 0318, Blindern, Oslo, Norway;Division of Gynecology and Obstetrics, Oslo University Hospital, Rikshospitalet, P.O.box 4950, 0424, Nydalen, Oslo, Norway;Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 1171, 0318, Blindern, Oslo, Norway;Department of Gynecology and Obstetrics, Drammen Hospital, P.O.box 800, 3004, Drammen, Norway;Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 1171, 0318, Blindern, Oslo, Norway;Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. box 1171, 0318, Blindern, Oslo, Norway;Norwegian National Advisory Unit on Women’s Health, Oslo University Hospital, P.o.box 4950, 0424, Nydalen, Oslo, Norway;Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Sogn Arena, P.O.box 4950, 0424, Nydalen, Oslo, Norway;

关键词: Postpartum hemorrhage;    Case-control study;    Predictors;    Risk factors;    Obstetric interventions;    High-risk;    Prediction;    Prevention;   

DOI  :  10.1186/s12884-016-1217-0

 received in 2016-05-07, accepted in 2016-12-29,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIn 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.MethodsWe 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.ResultsAmong 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).ConclusionsBased 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.

【 授权许可】

CC BY   
© The Author(s). 2017