Induction of Labor and Risk of Postpartum Hemorrhage in Low Risk Parturients

Abstract

ObjectiveLabor induction is an increasingly common procedure, even among women at low risk, although evidence to assess its risks remains sparse. Our objective was to assess the association between induction of labor and postpartum hemorrhage (PPH) in low-risk parturients, globally and according to its indications and methods.MethodPopulation-based case-control study of low-risk women who gave birth in 106 French maternity units between December 2004 and November 2006, including 4450 women with PPH, 1125 of them severe, and 1744 controls. Indications for labor induction were standard or non-standard, according to national guidelines. Induction methods were oxytocin or prostaglandins. Multilevel multivariable logistic regression modelling was used to test the independent association between induction and PPH, quantified as odds ratios.ResultsAfter adjustment for all potential confounders, labor induction was associated with a significantly higher risk of PPH (adjusted odds ratio, AOR1.22, 95%CI 1.04–1.42). This excess risk was found for induction with both oxytocin (AOR 1.52, 95%CI 1.19–1.93 for all and 1.57, 95%CI 1.11–2.20 for severe PPH) and prostaglandins (AOR 1.21, 95%CI 0.97–1.51 for all and 1.42, 95%CI 1.04–1.94 for severe PPH). Standard indicated induction was significantly associated with PPH (AOR1.28, 95%CI 1.06–1.55) while no significant association was found for non-standard indicated inductions.ConclusionEven in low risk women, induction of labor, regardless of the method used, is associated with a higher risk of PPH than spontaneous labor. However, there was no excess risk of PPH in women who underwent induction of labor for non-standard indications. This raises the hypothesis that the higher risk of PPH associated with labor induction may be limited to unfavorable obstetrical situations.

Does Labor Augmentation with Oxytocin Increase the Risk of Postpartum Hemorrhage? A Randomized Controlled Trial

“…Same findings was found by Khireddine et al, that in low risk women, induction of labor, regardless of the method used, is associated with a higher risk of PPH than spontaneous labor [11]. In 2013 a metaanalysis published on Cochrane library reviewed the effect of labor augmentation by oxytocin on the duration of first stage, fetal and maternal adverse effects and on the risk of conversion to cesarean section, they found that no significant effect on reduction of maternal and fetal adverse effects, conversion to cesarean section, but the was a significant effect on shortening of first stage [12].…”

A Prospective Study To Evaluate The Etiology & Continuum of Management Protocol of Postpartum Haemorrhage

“…The drugs used to induce labor might have a direct effect on the uterine muscle and could act as a fatigue factor (by causing supra physiological contractions) on the myometrium muscle and thus lead to postpartum atony and possibly PPH. 16 However, in the present study the incidence of PPH after induced labor was high but not statistically significant.…”

Efficacité et sécurité de l’acide tranexamique en prévention et/ou en traitement de l’hémorragie du post-partum : une revue systématique de la littérature avec méta-analyse

“…Compte tenu des faibles connaissances que nous avons en termes de dose optimale et d'effets secondaires, l'administration prophylactique ne pourrait être conseillé e que chez les patientes à haut risque d'hé morragie du post-partum, tenant compte de critè res validé s dans la litté rature (ané mie pendant la grossesse, anté cé dent d'hé morragie du post-partum, anomalie de placentation) [41][42][43].…”