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Atonic Postpartum Hemorrhage: Blood Loss, Risk Factors, and Third Stage Management.
Sarka Lisonkova1, Azar Mehrabadi2, Victoria M Allen3
1Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver BC; School of Population and Public Health, University of British Columbia, Vancouver BC.
Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|December 18, 2016
Summary
Diagnosis of atonic postpartum hemorrhage may be misclassified, potentially explaining recent increases in rates. This study analyzed blood loss, risk factors, and management in cases and controls.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Hemorrhage Research
Background:
- Atonic postpartum hemorrhage (PPH) rates are rising in industrialized nations.
- Understanding risk factors and management is crucial for addressing this trend.
Purpose of the Study:
- To examine blood loss, risk factors, and labor management associated with atonic PPH.
- To investigate potential misclassification in PPH diagnosis.
Main Methods:
- A case-control study involving 383 atonic PPH cases and 383 controls across eight Canadian tertiary care hospitals (2011-2013).
- Comparison of estimated blood loss, risk factors, and third-stage labor management between cases and controls.
- Conditional logistic regression used for confounding adjustment.
Main Results:
- Cases exhibited significantly higher mean estimated blood loss than controls.
- A notable percentage of both cases and controls had blood loss below diagnostic thresholds.
- Factors like nulliparity and vaginal birth after Cesarean section were associated with atonic PPH; Cesarean section delivery was a protective factor.
- Uterotonic use was higher in cases, while delayed cord clamping was less common in cases delivering vaginally.
Conclusions:
- Substantial misclassification exists in the diagnosis of atonic PPH.
- This diagnostic inaccuracy may contribute to the observed increase in PPH rates.
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