Prevalence and risk factors of severe obstetric haemorrhage

Abstract

Objective To determine the prevalence, causes, risk factors and acute maternal complications of severe obstetric haemorrhage.Design Population-based registry study.Population All women giving birth (307 415) from 1 January 1999 to 30 April 2004 registered in the Medical Birth Registry of Norway. Information about socio-economic risk factors was obtained from Statistics Norway.Methods Cross-tabulation was used to study prevalence, causes and acute maternal complications of severe obstetric haemorrhage. Associations of severe obstetric haemorrhage with demographic, medical and obstetric risk factors were estimated using multiple logistic regression models.Main outcome measure Severe obstetric haemorrhage (blood loss of > 1500 ml or blood transfusion).Results Severe obstetric haemorrhage was identified in 3501 women (1.1%). Uterine atony, retained placenta and trauma were identified causes in 30, 18 and 13.9% of women, respectively. The demographic factors of a maternal age of ‡30 years and South-East Asian ethnicity were significantly associated with an increased risk of haemorrhage. The risk was lower in women of Middle Eastern ethnicity, more than three and two times higher for emergency caesarean delivery and elective caesarean than for vaginal birth, respectively, and substantially higher for multiple pregnancies, von Willebrand's disease and anaemia (haemoglobin <9 g/dl) during pregnancy. Admissions to an intensive care unit, postpartum sepsis, hysterectomy, acute renal failure and maternal deaths were significantly more common among women with severe haemorrhage. ConclusionThe high prevalence of severe obstetric haemorrhage indicates the need to review labour management procedures. Demographic and medical risk factors can be managed with extra vigilance.Keywords Prevalence, risk factors, severe obstetric haemorrhage.Please cite this paper as: Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B. Prevalence and risk factors of severe obstetric haemorrhage.

Body Mass Index and Severe Postpartum Hemorrhage

“…Cesarean delivery is a well-recognized risk factor for severe PPH [13]. Among the women who had a vaginal delivery, a greater proportion of the cases underwent an operative vaginal delivery, another well-recognized risk factor for PPH [5,7,13]. We found that certain factors that may impair uterine contractility and affect systemic hemostasis were also risk factors for severe PPH.…”

“…While we controlled for mode of delivery (vaginal delivery vs. cesarean delivery before labor vs. cesarean delivery after labor), women who experienced severe PPH, had a higher rate of cesarean delivery (57%), compared to the cesarean delivery rate at our institution. Cesarean delivery is a well-recognized risk factor for severe PPH [13]. Among the women who had a vaginal delivery, a greater proportion of the cases underwent an operative vaginal delivery, another well-recognized risk factor for PPH [5,7,13].…”

“…Severe PPH has been variously defined as PPH requiring hysterectomy, PPH requiring intensive care, PPH resulting in organ damage and PPH requiring transfusion [11,12,13]. We defined severe PPH as PPH requiring transfusion.…”

Incidencia de hemorragia posparto con base en el uso terapéutico de uterotónicos. Resultados maternos en un hospital de mediana complejidad de Bogotá, Colombia

“…La incidencia de hemorragia obstétrica en el presente estudio fue de 2,1 %, menor a la reportada en la literatura mundial (4-6 %), y a la reportada previamente para la institución (1,3,8,13). La incidencia establecida por el empleo de medicamentos adicionales al manejo activo del alumbramiento, una vez excluidas las mujeres en las que se anotó la utilización preventiva de los uterotónicos posparto, fue 3,5 veces la incidencia reportada según la definición de caso utilizada por el Sistema de Vigilancia Epidemiológica (SIVIGILA).…”

How we manage the haematological aspects of major obstetric haemorrhage

“…factors identified antenatally may have a subsequent increased incidence of PPH whereas other high risk features may become apparent during labour and delivery, e.g., prolonged labour, and emergency caesarian section (Al-Zirqi et al, 2008). A recent study (Cook et al, 2013) has highlighted that women with multiple repeat caesarian section are at a significantly greater risk of MOH >1500 ml) [adjusted odds ratio (aOR), 18Á6; 95% confidence interval (CI), 3Á89-88Á8].…”