Background/Aims: The purpose of this study was to determine the relationship between maternal characteristics and severe postpartum hemorrhage (PPH). Methods: Medical records of women who delivered at Duke University Hospital between 2001 and 2004 with an ICD-9 code for PPH were reviewed. Women with PPH who received blood component therapy (severe PPH) were selected as cases and compared with controls matched for age, parity and mode of delivery. Results: Among 12,476 deliveries, there were 109 women with severe PPH. Hispanic women had an almost fourfold increase in the odds of severe PPH [OR 3.9 (1.8, 8.7)] that persisted when controlling for other significant predictors of PPH. Women with PPH were almost two times more likely [OR 1.8 (1.1, 3.1)] to have a BMI <30 when controlling for Hispanic ethnicity, oxytocin exposure, labor induction, treatment with magnesium and chorioamnionitis. Conclusion: Systemic factors as well as obstetrical factors modify the risk of severe PPH. Hispanic women and women with a BMI <30 are more likely to have severe PPH. When mode of delivery is controlled for, BMI ≧30 is associated with a reduced risk of severe PPH.

Bose P, Regan F, Paterson-Brown S: Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. BJOG 2006;113:919–924.
ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol 2006;108:1039–1047.
Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF: WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367:1066–1074.
Hogan MC, Foreman KJ, Naghavi M, et al: Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010;375:1609–1623.
Combs CA, Murphy EL, Laros RK Jr: Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol 1991;77:69–76.
Combs CA, Murphy EL, Laros RK Jr: Factors associated with hemorrhage in cesarean deliveries. Obstet Gynecol 1991;77:77–82.
Petersen LA, Lindner DS, Kleiber CM, Zimmerman MB, Hinton AT, Yankowitz J: Factors that predict low hematocrit levels in the postpartum patient after vaginal delivery. Am J Obstet Gynecol 2002;186:737–744.
Rouse DJ, Leindecker S, Landon M, et al: The MFMU Cesarean Registry: uterine atony after primary cesarean delivery. Am J Obstet Gynecol 2005;193:1056–1060.
Rouse DJ, MacPherson C, Landon M, et al: Blood transfusion and cesarean delivery. Obstet Gynecol 2006;108:891–897.
Clark SL, Yeh SY, Phelan JP, Bruce S, Paul RH: Emergency hysterectomy for obstetric hemorrhage. Obstet Gynecol 1984;64:376–380.
Bais JM, Eskes M, Pel M, Bonsel GJ, Bleker OP: Postpartum haemorrhage in nulliparous women: incidence and risk factors in low- and high-risk women. A Dutch population-based cohort study on standard (> or = 500 ml) and severe (> or = 1,000 ml) postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol 2004;115:166–172.
Sosa CG, Althabe F, Belizan JM, Buekens P: Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population. Obstet Gynecol 2009;113:1313–1319.
Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B: Prevalence and risk factors of severe obstetric haemorrhage. BJOG 2008;115:1265–1272.
Stones RW, Paterson CM, Saunders NJ: Risk factors for major obstetric haemorrhage. Eur J Obstet Gynecol Reprod Biol 1993;48:15–18.
Bianco AT, Smilen SW, Davis Y, Lopez S, Lapinski R, Lockwood CJ: Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol 1998;91:97–102.
Weiss JL, Malone FD, Emig D, et al: Obesity, obstetric complications and cesarean delivery rate – a population-based screening study. Am J Obstet Gynecol 2004;190:1091–1097.
James AH, Jamison MG, Brancazio LR, Myers ER: Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am J Obstet Gynecol 2006;194:1311–1315.
Larsen TB, Sorensen HT, Gislum M, Johnsen SP: Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study. Thromb Res 2007;120:505–509.
Smrtka M, Thames BH, Beckman M, Rawlins P, James AH: Obesity increases fibrinogen levels in pregnancy. Boston, International Society on Haemostasis and Thrombosis, 2009.
Charbit B, Mandelbrot L, Samain E, et al: The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost 2007;5:266–273.
Combs CA, Laros RK Jr: Prolonged third stage of labor: morbidity and risk factors. Obstet Gynecol 1991;77:863–867.
Hopkins RW, Fratianne RB, Rao KV, Damewood CA: Effects of hematocrit and viscosity on continuing hemorrhage. J Trauma 1974;14:482–493.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.