Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb;43(2):113-118.
doi: 10.1055/s-0040-1718439. Epub 2021 Jan 28.

Risk Factors for Postpartum Hemorrhage and its Severe Forms with Blood Loss Evaluated Objectively - A Prospective Cohort Study

Anderson Borovac-Pinheiro  1 , Filipe Moraes Ribeiro  1 , Rodolfo Carvalho Pacagnella  1
Affiliations

Risk Factors for Postpartum Hemorrhage and its Severe Forms with Blood Loss Evaluated Objectively - A Prospective Cohort Study

Anderson Borovac-Pinheiro et al. Rev Bras Ginecol Obstet. 2021 Feb.

Abstract
in English, Portuguese

Objective: To identify risk factors related to postpartum hemorrhage (PPH) and severe PPH with blood loss quantified objectively.

Methods: This is a complementary analysis of a prospective cohort study that included pregnant women delivering vaginally. The total blood loss was obtained through the sum of the volume collected from the drape with the weight of gauzes, compresses and pads used by women within 2 hours. Exploratory data analysis was performed to assess mean, standard deviation (SD), frequency, percentage and percentiles. The risk factors for postpartum bleeding were evaluated using linear and logistic regression.

Results: We included 270 women. The mean blood loss at 120 minutes was 427.49 mL (±335.57 mL). Thirty-one percent (84 women) bled > 500 mL and 8.2% (22 women) bled > 1,000 mL within 2 hours. Episiotomy, longer second stage of labor and forceps delivery were related to blood loss > 500 mL within 2 hours, in the univariate analysis. In the multivariate analysis, only forceps remained associated with bleeding > 500 mL within 2 hours (odds ratio [OR] = 9.5 [2.85-31.53]). Previous anemia and episiotomy were also related to blood loss > 1,000mL.

Conclusion: Prolonged second stage of labor, forceps and episiotomy are related to increased incidence of PPH, and should be used as an alert for the delivery assistants for early recognition and prompt treatment for PPH.

Objetivo: Identificar os fatores de risco para hemorragia pós-parto e hemorragia pós-parto grave com o sangramento pós-parto avaliado objetivamente. MéTODOS: Trata-se de uma análise complementar de um estudo de coorte prospectivo que incluiu somente mulheres que evoluíram para parto vaginal. O total de perda sanguínea foi avaliado objetivamente durante 24 horas pós-parto através da soma da quantidade de sangue mensurada através de um coletor de sangue pós-parto somado ao peso de compressas, gases e absorventes utilizados no período pós-parto. Análises exploratórias dos dados foram realizadas através do cálculo de médias, desvio-padrão (DP), frequência, porcentagem e percentis. Os fatores de risco foram avaliados através de regressão linear e logística.

Resultados: Foram incluídas 270 mulheres. A média de perda sanguínea pós-parto após 120 minutos foi de 427.49 mL (±335.57 mL). Trinta e um por cento (84 mulheres) sangraram > 500 mL e 8,2% (22 mulheres) sangraram > 1.000 mL em 2 horas. Episiotomia, segundo período do parto prolongado e uso de fórceps estiveram associados a perda sanguínea > 500 mL em 2 horas. Na análise multivariada, somente fórceps manteve-se entre os fatores de risco para sangramentos superiores a 500 mL em 2 horas (odds ratio [OR] = 9.5 [2.85–31.53]). Anemia prévia e episiotomia estiveram associadas com perda sanguínea > 1.000 mL. CONCLUSãO: Segundo período do parto prolongado, fórceps e episiotomia estão associados a aumento da incidência de hemorragia pós-parto e devem ser usados como um alerta para os profissionais de saúde para o reconhecimento precoce e tratamento imediato da patologia.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflict of interests to declare.

Figures

Fig. 1
Fig. 1
Calibrated drape used to measure objectively blood loss after fetal delivery (BRASSS_V drape_Maternova_Providence, RI, USA).
See this image and copyright information in PMC

References

    1. Kendall T, Langer A. Critical maternal health knowledge gaps in low- and middle-income countries for the post-2015 era. Reprod Health. 2015;12:55. doi: 10.1186/s12978-015-0044-5. - DOI - PMC - PubMed
    1. Knaul F M, Langer A, Atun R, Rodin D, Frenk J, Bonita R. Rethinking maternal health. Lancet Glob Health. 2016;4(04):e227–e228. doi: 10.1016/S2214-109X(16)00044-9. - DOI - PubMed
    1. GBD 2015 Maternal Mortality Collaborators Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 Lancet 2016388(10053):1775–1812.10.1016/S0140-6736(16)31470-2 - DOI - PMC - PubMed
    1. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(06):e323–e333. doi: 10.1016/S2214-109X(14)70227-X. - DOI - PubMed
    1. World Health Organization . Tunçalp O, Souza J P, Gülmezoglu M. New WHO recommendations on prevention and treatment of postpartum hemorrhage. Int J Gynaecol Obstet. 2013;123(03):254–256. doi: 10.1016/j.ijgo.2013.06.024. - DOI - PubMed

LinkOut - more resources