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Risk Factors for Severe Postpartum Hemorrhage among Women undergoing Prelabor Cesarean Delivery
Abstract Number: T-21
Abstract Type: Original Research
Introduction: Compared to vaginal delivery, women who undergo cesarean delivery (CD) are at increased risk of postpartum hemorrhage (PPH).(1,2) Because key differences exist in the characteristics of women who undergo prelabor CD compared to intrapartum CD, the risk profile of women who experience PPH likely differs across each CD population. The aim of this study was to examine risk factors for severe PPH among women undergoing prelabor CD.
Methods: After IRB approval, we performed a nested case-control study within a cohort of 819 women who underwent intrapartum CD at large US obstetric center between 2002 and 2012. Data were abstracted from medical records for clinical, obstetric, and laboratory information. Maternal and obstetric characteristics were compared for 269 women who experienced severe PPH and 550 matched controls (no severe PPH). Severe PPH was classified by an EBL ≥1500 mL or RBC transfusion within 48 hr post-CD. Multivariate logistic regression analyses was performed to identify independent risk factors for severe PPH, which included variables with a P value<0.1 in the univariate analyses.
Results: Among all cases, 223 (82.9%) women had at least 1500 ml EBL, 91 (33.8%) women received RBC intraoperatively, and 90 (33.5%) women received RBC within 48 hr post-CD. Clinical factors independently associated with severe PPH are presented in Table 1. Clinical factors with the highest adjusted odds of severe PPH were general anesthesia (aOR=19.9), multiple pregnancy (aOR=8.0), and previa (aOR=6.5). In a sensitivity analysis excluding women with abnormal placentation (n=51), we observed only modest changes in the point estimates in our final logistic model (data not presented).
Conclusion: Our findings indicate that women with previa, multiple pregnancy or those who undergo general anesthesia are at highest risk for severe PPH during prelabor CD. These findings may assist providers in triaging patients for severe PPH prior to prelabor CD and may optimize preoperative blood ordering practices.
References: (1) Anesth Analg 2010; 110:1368-73. (2) BJOG 2008;115: 1265-72