Identifying women most likely to benefit from prevention strategies for postpartum hemorrhage

Abstract

Objective: To identify women who are most likely to benefit from primary prevention strategies for postpartum hemorrhage (PPH).Study Design: In a retrospective patient cohort, we applied recursive partitioning algorithms to identify the most discriminant risk factors and their interactions, and calculated the 'number needed to treat' to prevent a single case of PPH (estimated blood loss >1000 ml).Result: By delivery category, the highest risk groups with 'number needed to treat' ranging from 4 to 7 were: (1) vaginal delivery (PPH ¼ 0.7% of 16 218)Fmacrosomia with gestational diabetes and manual removal of the placenta; (2) primary cesarean (PPH ¼ 18.7% of 2696)Fmacrosomia and multiparity; and (3) repeat cesarean (PPH ¼ 16.0% of 1832)Futerine incision other than low transverse and failed vaginal birth after cesarean. Conclusion:Clinical profiles that identify women at risk for PPH can provide a foundation for the development of primary prevention strategies.

In Vitro Fertilization Pregnancy is One of the Risk Factor for Atonic Bleeding in Problem-Free Pregnancy

“…The association of greater infant weight with poor contraction of the uterus has already been reported [19,22]. Although the indications for instrumental delivery have to be considered in detail, obstructed labor is the most common reason.…”

“…There were also many reports of PPH risk during the stages of labor [1,[15][16][17][18][19][20][21][22][23][24]. The existence of these factors suggests a risk for PPH before delivery, but abnormal PPH still occurs with a constant probability when these factors are absent.…”

How I treat postpartum hemorrhage

“…Uterine atony ("Tone") is the most common cause; failure of the myometrium to contract allows continued bleeding from the spiral arteries. Risk factors for uterine atony are well established, 69,70 however, they only have moderate positive predictive value for PPH and hence limited clinical utility. Most cases of uterine hemorrhage are not predictable but for those with known preexisting factors, such as placenta previa or previous PPH, we discuss and agree upon a delivery plan in advance.…”

Placental weight and excess postpartum haemorrhage: a population study of 308 717 pregnancies

“…1 To prevent the condition from occurring, and to provide prompt and accurate treatment, knowledge of risk factors for excess postpartum haemorrhage is essential. 2,3 Previous research suggests that parity, high offspring birthweight, labour dystocia and caesarean section are factors that may increase the risk of excess haemorrhage. [4][5][6][7][8][9] In addition, complications that are closely linked to the placenta, including placenta praevia, placental abruption, as well as a retained placenta and pre-eclampsia, have been related to excess postpartum haemorrhage.…”

“…[4][5][6][7][8][9] In addition, complications that are closely linked to the placenta, including placenta praevia, placental abruption, as well as a retained placenta and pre-eclampsia, have been related to excess postpartum haemorrhage. 3,[6][7][8][9][10] A large placenta will typically have a large surface area attached to the uterine wall, and it is therefore conceivable that large placental size is associated with increased risk of excess postpartum haemorrhage. Such an association may partly explain why women who deliver large babies are at higher risk of postpartum haemorrhage 5 because birthweight and placental weight are strongly correlated.…”