Original Article

Postpartum Hemorrhage After Cesarean Delivery: An Analysis of Risk Factors

Authors: Everett F. Magann, MD, Sharon Evans, PHD, Maureen Hutchinson, RN, RM, Robyn Collins, RN, RM, BAPPSC, CHC, Grainger Lanneau, MD, John C. Morrison, MD

Abstract

Objective: To determine the incidence and risk factors for postpartum hemorrhage (PPH) associated with cesarean delivery.


Methods: Blood loss at cesarean delivery was measured and defined as 1,000 to 1,499 mL or greater than 1,500 mL and/or the need for a blood transfusion. Variables were identified and evaluated to determine the factors associated with PPH.


Results: There were 1,844 elective and 2,993 nonelective cesarean deliveries over 4 years. The PPH rate in nonelective cesarean (6.75%) was greater than after elective cesarean (4.84%, P = 0.007). Risk factors for PPH after an elective operation included leiomyomata, blood disorders, placenta previa, antepartum bleeding, preterm birth, and general anesthesia. Nonelective cesarean PPH risk factors included blood disorders, retained placenta, antepartum transfusion, antepartum/intrapartum hemorrhage, placenta previa, general anesthesia, and macrosomia (odds ratio >1.5, confidence interval >1.5).


Conclusions: Nonelective cesarean deliveries have a higher risk of PPH than women delivered electively. Risk factor identification and prevention should be a priority.


Key Points


* The postpartum hemorrhage (PPH) rate in nonelective abdominal birth (6.75%) is greater than after elective cesarean (4.84%, P = 0.007).


* Identified risk factors for PPH after an elective operation included leiomyomata, placenta previa, antepartum bleeding, preterm birth, and general anesthesia.


* Nonelective cesarean PPH risk factors include blood disorders, retained placenta, antepartum transfusion, antepartum/intrapartum hemorrhage, placenta previa, general anesthesia, and macrosomia.

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