Risk Factors for Severe Postpartum Hemorrhage After Cesarean Delivery: Case-Control Studies
- 1 August 2017
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Anesthesia & Analgesia
- Vol. 125 (2), 523-532
- https://doi.org/10.1213/ane.0000000000001962
Abstract
BACKGROUND: Women who undergo intrapartum caesarean delivery (CD) are at increased risk of postpartum hemorrhage (PPH) compared with those undergoing prelabor CD. To determine whether the presence and strength of the associations between individual risk factors and severe PPH vary among women undergoing prelabor CD or intrapartum CD, stratified analyses are needed according to CD subtype. METHODS: To identify risk factors for severe PPH within 2 distinct CD populations, prelabor CD and intrapartum CD, we performed 2 case-control studies. Women in each study cohort delivered at a tertiary obstetric center in the United States between 2002 and 2012. For each study, cases were women who had a blood loss ≥1500 mL or who received an intraoperative or postoperative transfusion up to 48 hours after delivery. Risk factors for severe PPH among women undergoing prelabor CD or intrapartum CD were examined in separate logistic regression models. RESULTS: For prelabor CD, we identified 269 cases and 550 controls. Clinical factors with the highest adjusted odds for severe PPH during prelabor CD were general anesthesia (adjusted odds ratio [aOR] = 22.3; 95% confidence interval [CI], 4.9–99.9; reference group = spinal anesthesia), multiple pregnancies (aOR = 8.0; 95% CI, 4.2–15.0; reference group = singleton pregnancy), and placenta previa (aOR = 6.3; 95% CI, 3.4–11.8). For intrapartum CD, we identified 278 cases and 572 controls. Clinical factors with the highest adjusted odds for severe PPH during intrapartum CD were general anesthesia (aOR = 5.4; 95% CI, 1.7–17.1), multiple pregnancies (aOR = 3.2; 95% CI, 1.7–6.3), and a predelivery hemoglobin ≤ 9.9 g/dL (aOR = 3.0; 95% CI, 1.3–6.9; reference group = predelivery hemoglobin ≥ 11 g/dL). CONCLUSIONS: Women who undergo prelabor CD and intrapartum CD have several shared risk factors for severe PPH (general anesthesia and multiple pregnancies). However, the risk factor profiles for severe PPH differed between these CD cohorts. Recognizing these differences may be important when planning resources and interventions for high-risk patients undergoing either prelabor or intrapartum CD.Keywords
This publication has 51 references indexed in Scilit:
- Massive Blood Transfusion During Hospitalization for Delivery in New York State, 1998–2007Obstetrics & Gynecology, 2013
- Epidemiological investigation of a temporal increase in atonic postpartum haemorrhage: a population‐based retrospective cohort studyBJOG: An International Journal of Obstetrics and Gynaecology, 2013
- Risk factors for failed conversion of labor epidural analgesia to cesarean delivery anesthesia: a systematic review and meta-analysis of observational trialsInternational Journal of Obstetric Anesthesia, 2012
- Blood loss after cesarean delivery: a registry-based study in Norway, 1999-2008American Journal of Obstetrics and Gynecology, 2012
- Anesthetic management of patients with placenta accreta and resuscitation strategies for associated massive hemorrhageCurrent Opinion In Anesthesiology, 2011
- Contemporary cesarean delivery practice in the United StatesAmerican Journal of Obstetrics and Gynecology, 2010
- The association between the length of first stage of labor, mode of delivery, and perinatal outcomes in women undergoing induction of laborAmerican Journal of Obstetrics and Gynecology, 2009
- Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative GroupBMC Pregnancy and Childbirth, 2009
- Maternal Morbidity Associated With Multiple Repeat Cesarean DeliveriesObstetrics & Gynecology, 2006
- Translating Clinical Research into Clinical Practice: Impact of Using Prediction Rules To Make DecisionsAnnals of Internal Medicine, 2006