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

BMC Pregnancy Childbirth. 2017 Jan 10;17(1):17. doi: 10.1186/s12884-016-1217-0.

Abstract

Background: In high-income countries, the incidence of severe postpartum hemorrhage (PPH) has increased. This has important public health relevance because severe PPH is a leading cause of major maternal morbidity. However, few studies have identified risk factors for severe PPH within a contemporary obstetric cohort.

Methods: We performed a case-control study to identify risk factors for severe PPH among a cohort of women who delivered at one of three hospitals in Norway between 2008 and 2011. A case (severe PPH) was classified by an estimated blood loss ≥1500 mL or the need for blood transfusion for excessive postpartum bleeding. Using logistic regression, we applied a pragmatic strategy to identify independent risk factors for severe PPH.

Results: Among a total of 43,105 deliveries occurring between 2008 and 2011, we identified 1064 cases and 2059 random controls. The frequency of severe PPH was 2.5% (95% confidence interval (CI): 2.32-2.62). The most common etiologies for severe PPH were uterine atony (60%) and placental complications (36%). The strongest risk factors were a history of severe PPH (adjusted OR (aOR) = 8.97, 95% CI: 5.25-15.33), anticoagulant medication (aOR = 4.79, 95% CI: 2.72-8.41), anemia at booking (aOR = 4.27, 95% CI: 2.79-6.54), severe pre-eclampsia or HELLP syndrome (aOR = 3.03, 95% CI: 1.74-5.27), uterine fibromas (aOR = 2.71, 95% CI: 1.69-4.35), multiple pregnancy (aOR = 2.11, 95% CI: 1.39-3.22) and assisted reproductive technologies (aOR = 1.88, 95% CI: 1.33-2.65).

Conclusions: Based on our findings, women with a history of severe PPH are at highest risk of severe PPH. As well as other established clinical risk factors for PPH, a history of severe PPH should be included as a risk factor in the development and validation of prediction models for PPH.

Keywords: Case-control study; High-risk; Obstetric interventions; Postpartum hemorrhage; Prediction; Predictors; Prevention; Risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anemia / complications
  • Anticoagulants / adverse effects
  • Blood Transfusion / statistics & numerical data
  • Case-Control Studies
  • Cohort Studies
  • Delivery, Obstetric / adverse effects*
  • Female
  • Humans
  • Leiomyoma / complications
  • Logistic Models
  • Norway
  • Placenta Diseases / etiology*
  • Postpartum Hemorrhage / etiology*
  • Pre-Eclampsia / etiology
  • Pregnancy
  • Pregnancy, Multiple
  • Reproductive Techniques, Assisted / adverse effects
  • Risk Factors
  • Uterine Inertia / etiology*
  • Uterine Neoplasms / complications

Substances

  • Anticoagulants

Associated data

  • figshare/10.6084/m9.figshare.4042839.v1