Risk Factors for Severe Postpartum Hemorrhage After Cesarean Delivery: Case-Control Studies

Butwick, Alexander J.; Ramachandran, Bharathi; Hegde, P.; Riley, Edward T.; El‐Sayed, Yasser Y.; Nelson, Lorene M.

doi:10.1213/ane.0000000000001962

Cited by 93 publications

(90 citation statements)

References 49 publications

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“…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

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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.

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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

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“…These factors include previous cesarean delivery, hypertensive disorders of pregnancy, fibroids, placenta previa, etc. [4,[9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Risk Factors of Severe Postpartum Hemorrhage: a Retrospective Cohort Study

Liu

et al. 2020

Preprint

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Background: Although maternal deaths are rare in developed regions, the morbidity associated with severe postpartum hemorrhage remains a major problem. To provide new insight into severe postpartum hemorrhage, we analyzed data of women giving birth in Guangzhou Medical Centre for Critical Pregnant Women, which receiveda large quantity of critically ill obstetric patients from other hospitals of Southern China. Methods: In this study, we conducted a retrospective cohort by using the criteria of severe maternal morbidities, which was defined by estimation of blood loss volume and use of blood transfusion≥4 units, to determine the prevalence, risk factors and short-term complications of severe postpartum hemorrhage. Results: Severe postpartum hemorrhage was observed in 532 mothers (1.56%) among the total population of 34 178 mothers. Placental related cause (55.83%) was the major identified cause of severe postpartum hemorrhage, while uterine atony without associated retention of placental tissues accounted for 38.91%. The risk factors for severe postpartum hemorrhage were maternal age<18 years, previous cesarean section, history of postpartum hemorrhage, conception through in vitro fertilization, pre-delivery anemia, stillbirth, prolonged labor, placenta previa, placental abruption, placenta accrete spectrum and macrosomia. The prevalence rates of admission to ICU, hysterectomy, acute renal failure and sepsis were significantly higher in women with severe postpartum hemorrhage. Conclusion:The results of this study suggested that severe postpartum hemorrhagecould be adopted as an indicator to assess the quality of obstetric care because of its severity and potential lethality. Extra vigilance during the antenatal and peripartum periods is needed to identify women who have risk factors and enable early intervention to prevent severe postpartum hemorrhage. It’s important to remember that we have to prepare for all mothers giving birth, as some get severe postpartum hemorrhagewithout any known risk factors.

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“…The cohorts were sourced from prior case-control studies examining risk factors for PPH during prelabor CD and intrapartum CD. 18 The study was approved by the Stanford University IRB (Protocol ID=25236).…”

Section: Methodsmentioning

confidence: 99%

Obstetric interventions and maternal morbidity among women who experience severe postpartum hemorrhage during cesarean delivery

Seligman

Ramachandran

Hegde

et al. 2017

International Journal of Obstetric Anesthesia

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Background Compared to vaginal delivery, women undergoing cesarean delivery are at increased risk of postpartum hemorrhage. Management approaches may differ between those undergoing prelabor cesarean delivery compared to intrapartum cesarean delivery. We examined surgical interventions, blood component use, and maternal outcomes among those experiencing severe postpartum hemorrhage within the two distinct cesarean delivery cohorts. Methods We performed secondary analyses of data from two cohorts who underwent prelabor cesarean delivery or intrapartum cesarean delivery at a tertiary obstetric center in the United States between 2002 and 2012. Severe postpartum hemorrhage was classified as an estimated blood loss ≥ 1500 mL or receipt of a red blood cell transfusion up to 48 h post-cesarean delivery. We examined blood component use, medical and surgical interventions and maternal outcomes. Results The prelabor cohort comprised 269 women and the intrapartum cohort comprised 278 women. In the prelabor cohort, one third of women received red blood cells intraoperatively or postoperatively, respectively. In the intrapartum cohort, 18% women received red blood cells intraoperatively vs. 44% postoperatively (P<0.001). In the prelabor and intrapartum cohorts, methylergonovine was the most common second-line uterotonic (33% and 43%, respectively). Women undergoing prelabor cesarean delivery had the highest rates of morbidity, with 18% women requiring hysterectomy and 16% requiring intensive care admission. Conclusion Our findings provide a snapshot of contemporary transfusion and surgical practices for severe postpartum hemorrhage management during cesarean delivery. To determine optimal transfusion and management practices in this setting, large pragmatic studies are needed.

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Risk Factors for Severe Postpartum Hemorrhage After Cesarean Delivery: Case-Control Studies

Cited by 93 publications

References 49 publications

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

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

Prevalence and Risk Factors of Severe Postpartum Hemorrhage: a Retrospective Cohort Study

Obstetric interventions and maternal morbidity among women who experience severe postpartum hemorrhage during cesarean delivery

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