(404) Risk factors for early severe post-partum hemorrhage

Postpartum hemorrhage (PPH) is an obstetric emergency whose severity is determined according to the amount of blood loss. We sought to find prominent risk factors for early severe PPH.

Study Design:

A population-based cohort study including consecutive deliveries between 1991 and 2016 at a tertiary medical center was conducted. Early PPH was defined as estimated blood loss exceeding 500 ml within 24 h after delivery. Risk factors for early PPH were examined in two groups based on the severity of bleeding; assuming that severe cases required additional treatment with blood products. Generalized estimating equation (GEE) models were constructed in order to control for confounders.

Results:

Early PPH complicated 0.5% (n=1811) of all deliveries enrolled in the study (n=322,497); of these 28% (n=505) required blood products and were defined as severe PPH.  Risk factors for severe PPH were macrosomia, previous cesarean delivery (CD), IVF pregnancies, preeclampsia, prolonged 2^nd stage of labor, induction of labor, placental abruption, placenta previa and uterine rupture (Table 1). Using several GEE logistic regression models, controlling for maternal age and gestational age at birth, all these risk factors demonstrated an independent association for early severe PPH (Table 2).

Conclusion:

Uterine rupture, placenta previa, placental abruption, prolonged 2^nd stage of labor, macrosomia, preeclampsia, IVF pregnancy, induction of labor and previous cesarean delivery are all independent risk factor for early severe PPH. Special attention should be given to women with these risk factor in order to prevent early severe PPH.