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

Nyfløt, Lill Trine; Sandven, Irene; Stray‐Pedersen, Babill; Pettersen, Silje; Al-Zirqi, Iqbal; Rosenberg, Margit; Jacobsen, Anne Flem; Vangen, Siri

doi:10.1186/s12884-016-1217-0

Cited by 230 publications

(285 citation statements)

References 39 publications

(38 reference statements)

Supporting

Mentioning

215

Contrasting

Unclassified

Order By: Relevance

“…Second, there is some evidence that the chronic hypoxic environment caused by anemia can upregulate or dysregulate placental vascularity, which may increase the vulnerability of the placenta and uterus to vascular fragility and PPH. Third, anemia has been associated in some studies, with uterine atony (implicated in PPH), perhaps related to tissue iron deficiency. Fourth, postpartum blood loss of <500 mL (not meeting the standard definitions of PPH), which is the volume of a blood donation and therefore considered inconsequential for nonanemic individuals, may be poorly tolerated in patients with low hemoglobin levels.…”

Section: Discussionmentioning

confidence: 99%

Maternal death and postpartum hemorrhage in sub‐Saharan Africa – A pilot study in metropolitan Mozambique

Lancaster

Barnes

Correia

et al. 2020

Research and Practice in Thrombosis and Haemostasis

View full text Add to dashboard Cite

Background Maternal mortality in sub‐Saharan Africa is approximately 500 to 1000 per 100 000 births (vs. approximately 5‐20 in developed countries). Postpartum hemorrhage (PPH) is deemed responsible for 30% to 50% of the deaths. Objective To study PPH, risk factors, and mortality in metropolitan Mozambique to inform future studies and intervention strategies. Materials/Methods Retrospective cross‐sectional data extraction from all charts available to us (n = 495) recording deliveries between January and June 2018 at Maputo Central Hospital. Data included age, maternal survival, HIV status, parity, delivery mode, complications, vital signs, laboratory values, and maternal/fetal data. PPH was determined by charted diagnosis, interventions for hemorrhaging, placental abruption, transfusion, or blood loss. Autopsy reports from all deceased patients (n = 35) were examined. Results Median age was 29 years with 17% HIV prevalence. Risk factors for PPH (frequency, 12%) included parity (adjusted odds ratios (AORs) for 3+ versus nulliparity, 7.20 (95% confidence interval [CI], 2.46‐21.10), gestation length (AOR, 0.86; CI, 0.81‐0.92 per week), and body temperature (AOR, 1.10; CI, 1.04‐1.16 per 0.1°C). Maternal mortality was strongly associated with PPH (AOR, 5.22; 95% CI, 2.26‐12.08) and HIV (AOR, 11.66; 95% CI, 4.72‐28.78). Laboratory values (n = 241) were available from mothers experiencing complications (approximately 50%). Anemia (prevalence 54%) was a strong predictor of PPH with an inverse relationship between hemoglobin levels on admission (AOR, 0.62; 95% CI, 0.50‐0.77 per g/dL higher hemoglobin) and the probability of later suffering from PPH. Mothers who died following PPH had lower median hemoglobin (6.2 g/dL) than mothers who survived (9.2 g/dL). Protocols to estimate peripartum blood loss were not used; antifibrinolytics and/or cryoprecipitate were unavailable. Conclusion Postpartum hemorrhage is a serious problem even in metropolitan areas of sub‐Saharan Africa, and anemia influenced bleeding and death substantially. To address this problem, it is critical to raise awareness and region‐specific prevention and intervention protocols.

show abstract

Section: Discussionmentioning

confidence: 99%

Maternal death and postpartum hemorrhage in sub‐Saharan Africa – A pilot study in metropolitan Mozambique

Lancaster

Barnes

Correia

et al. 2020

Research and Practice in Thrombosis and Haemostasis

View full text Add to dashboard Cite

show abstract

“…This finding is congruent with the previous research studies conducted in Thailand that the rates of PPH varied across the hospitals [4,5] There are two mains factors associated with PPH were maternal and health service factors. Some characteristics of women are already known as risk factors of PPH, such as age > 35 years old [6], severe perineum lacerations [26], anemia and multiple pregnancy [11]. However, these variables were not predictive factors for PPH in this study except they showed history of PPH and delivered a baby with a weight of more than 3500 g. The findings reveal that those women who experienced PPH are more likely to have increased the odds of PPH than those without, this congruent with previous studies that past history of PPH is associated with PPH [27,28].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, complications during pregnancy, such as pregnant women with diabetes mellitus [9] and pregnant women with chronic anemia [6,10] appear to also increase the risk of PPH. Women with a past history of PPH were more likely to experience PPH than others [11]. Obstetric factors are another compounding factors that increase the risk for PPH; such as multiple pregnancy [12,13] and the baby weight of 4000 g or more [14].…”

Section: Introductionmentioning

confidence: 99%

Maternal and health service predictors of postpartum hemorrhage across 14 district, general and regional hospitals in Thailand

Prapawichar

Ratinthorn

Utriyaprasit

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background: Postpartum hemorrhage (PPH) is a preventable complication, however, it remains being the leading cause of maternal mortality and morbidity worldwide including Thailand. Methods: A case-control study to examine the risk factors associated with PPH across the hospitals under the Ministry of Public Health in Thailand, was conducted. A total of 1833 patient birth records and hospital profiles including human and physical resources from 14 hospitals were obtained. A multiple logistic regression was used identifing the factors that are significantly associated with PPH. Results:The results show that the rate of PPH varied across the hospitals ranging from 1.4 to 10.6%. Women with past history of PPH were more likely to have increased risk of having PPH by 10.97 times (95% CI 2.27,53.05) compared to those who did not. The odds of PPH was higher in district and general hospitals by 14 (95% CI 3.95, 50.04) and 7 (95% CI 2.27,23.27) times respectively, compared to regional hospitals. The hospitals which had inadequate nurse midwife to patient ratio (OR 2.31,95% CI 1.08,4.92), lacked nurse midwives with working experience of 6-10 years (OR 2.35, 95% CI 1.41,3.92), as well as inadequate equipment and supplies for emergency obstetric care (OR 6.47, 95% CI 1.93,21.63), had significantly higher incidence of having PPH, respectively. Conclusions:This study provides interesting information that the rate of PPH varies across the hospitals in Thailand, in particular where essential nurse midwives, equipment, and supplies are limited. Therefore, improving health care services by allocating sufficient human and physical resources would contribute to significantly reduce this complication.

show abstract

“…The increase of severe PPH is not due to changes in risk factors over time, but to an unexplainable higher incidence of uterine atony 213,218,219 . However, recently previous severe PPH is found to be the strongest independent risk factor in addition to retained placenta tissue on the risk of severe PPH 321 . The increasing rates of abnormal placentation are associated to increasing cesarean section rates affecting the risk of near miss cases and the maternal morbidity 322,323 .…”

Section: Postpartum Hemorrhagementioning

confidence: 86%

Can oxytocin augmentation modify the risk of epidural analgesia by maternal age in cesarean sections?

Rossen

Klungsøyr

Albrechtsen

et al. 2018

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

Printed by NTNU Grafisk senter Stimulering av rier med oxytocin og sammenheng med fødselsutfallOxytocin blir ofte brukt under fødselen for å øke styrken på riene. Mangel på klare indikasjoner for bruk av oxytocin har ført til ulik praksis og tilfeldig bruk. Hensikten med studien var å undersøke om det kan vaere en sammenheng mellom bruken av oxytocin og hvordan fødselen blir for kvinnen og for barnet. Studie I Vi undersøkte retrospektivt risikofaktorer for blødning over 1000 ml etter fødselen og om dette hadde endret seg fra 1998 til 2007. Blødning over 1000 ml økte i studieperioden og risikoen var dobbelt så stor etter keisersnitt sammenlignet med vaginal fødsel (2.8 % vs. 5.9 %). Igangsetting av fødsel, stimulering av rier og keisersnittfrekvens økte, og disse faktorene viste sammenheng med alvorlig blødning etter fødselen. Bruk av oxytocin for stimulering av rier økte fra 5.8 % til 29.3 %. Studie II Målet med denne studien var å presentere en metode for å evaluere og kvalitetssikre utfall og hendelser for mor og barn i forbindelse med fødsel. Michael Robson har laget en metode der fødende kvinner kan klassifiseres i ti ulike grupper. Metoden ble først utviklet for å klassifisere bruken av keisersnitt. I denne studien presenterer vi hvordan vi kan klassifisere 16 fødselsutfall i henhold til de ti gruppene. Vi presenterer resultater fra fødeavdelinger i Stavanger, Dublin og nasjonale data fra Slovenia. Studie III Fødeavdelingen ved Stavanger universitetssjukehus endret indikasjonene og rutinene for oxytocinbruk i 2010. I løpet av en 5 års periode ble bruken av oxytocin under fødselen signifikant redusert fra 35.5 % til 23.6 %. Antall akutte keisersnitt og antall barn med lav pH i navlesnora gikk ned i samme tidsperiode og vi diskuterer om dette kan ha en sammenheng med redusert bruk av oxytocin. Flere kvinner opplevde blødning over 1000ml og varighet av fødsel over 12 timer. Studie IV Fødselsregistrene i Norge og Danmark ble brukt for å undersøke bruken av oxytocin for ristimulering hos førstegangsfødende kvinner med spontan fødselstart til termin. Vi fant at bruk av oxytocin økte med kvinnenes alder, bruk av epiduralbedøvelse og med akutte keisersnitt. Formålet med studien var å vurdere samspillet mellom disse faktorene. Ristimulering viste sammenheng med lavere forekomst av keisersnitt hos kvinner med epiduralbedøvelse, spesielt hos kvinner over 35 år. Konklusjon Målrettet bruk av oxytocin for stimulering av rier førte til redusert bruk av oxytocin og viste sammenheng med faerre akutte keisersnitt og faerre barn med lav pH i navlesnora. Kvinner med epiduralbedøvelse kan imidlertid ha fordel av ristimulering. Flere ulike faktorer har innvirkning på fødselsforløp og fordeler og ulemper må vurderes i forhold til hverandre. Robsons 10-gruppe klassifikasjonssystem kan vaere et nyttig hjelpemiddel for å kvalitetssikre fødselsutfall og for å sammenligne ulike fødeavdelinger. Kristiansand, fredag 16.juni 2017 kl.12.15

show abstract

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

Cited by 230 publications

References 39 publications

Maternal death and postpartum hemorrhage in sub‐Saharan Africa – A pilot study in metropolitan Mozambique

Maternal death and postpartum hemorrhage in sub‐Saharan Africa – A pilot study in metropolitan Mozambique

Maternal and health service predictors of postpartum hemorrhage across 14 district, general and regional hospitals in Thailand

Can oxytocin augmentation modify the risk of epidural analgesia by maternal age in cesarean sections?

Contact Info

Product

Resources

About