Table 3.
Risk pathways for progression of PPH from ≥500 ml to severe PPH ≥ 1500 ml according to chronological variables grouped as prepregnancy, during pregnancy, labour and birth
| Risk factors included in final model (1230 women included; 70 excluded due to missing data in addition to all women with EBL<500 ml) | Prepregnancy Variable subgroups 1–4 OR (95% CI), P | During pregnancy Variable subgroups 1–10 OR (95% CI), P | Labour and birth Variable subgroups 1–16 OR (95% CI), P |
|---|---|---|---|
| (1) Sociodemographic | |||
| Age, for each 10 years | 0.85 (0.67–1.07), 0.16 | 0.90 (0.68–1.09), 0.20 | 0.99 (0.77–1.29), 0.96 |
| Black African | 0.86 (0.62–1.19), 0.36 | 0.84 (0.61–1.17), 0.31 | 0.91 (0.64–1.30), 0.61 |
| (2) Local Deprivation: index of multiple deprivation, most deprived UK quintile (%) | |||
| Barriers to housing and services | 0.79 (0.60–1.03), 0.076 | 0.78 (0.59–1.02), 0.069 | 0.75 (0.56–1.01), 0.055 |
| Education, skills and training | 1.75 (1.11–2.74), 0.015 | 1.84 (1.16–2.92), 0.009 | 1.82 (1.10–3.00), 0.019 |
| (3) General and medical risk factors | |||
| Current smoker | 0.59 (0.36–0.97), 0.039 | 0.56 (0.33–0.93), 0.026 | 0.67 (0.38–1.17), 0.16 |
| BMI (kg/m2) per unit | 1.03 (1.00–1.05), 0.022 | 1.03 (1.00–1.05), 0.023 | 1.04 (1.01–1.06), 0.008 |
| Assisted conception | 1.41 (0.79–2.50), 0.25 | 1.02 (0.53–1.93), 0.096 | 1.18 (0.60–2.35), 0.64 |
| (4) Previous obstetric history | |||
| Previous PPH | 1.79 (1.06–3.02), 0.030 | 1.93 (1.13–3.31), 0.016 | 2.39 (1.33–4.28), 0.003 |
| Multiparous previous caesarean | 0.70 (0.49–1.01), 0.055 | 0.63 (0.43–0.92), 0.018 | 0.84 (0.54–1.30), 0.43 |
| Multiparous no previous caesarean | 1.65 (1.20–2.28), 0.002 | 1.55 (1.12–2.16), 0.009 | 1.17 (0.80–1.74), 0.42 |
| (5) Current pregnancy | |||
| Multiple pregnancy | 2.00 (1.05–3.82), 0.035 | 2.60 (1.27–5.38), 0.009 | |
| Admissions >24 weeks | 0.67 (0.44–1.02), 0.062 | 0.83 (0.53–1.32), 0.43 | |
| (6) Antenatal day unit (ADU) attendances | |||
| Any ADU attendance | 1.17 (0.89–1.56), 0.26 | 1.05 (0.77–1.43), 0.75 | |
| Pre-eclampsia screen | 0.93 (0.55–1.57), 0.80 | 1.15 (0.66–2.01), 0.62 | |
| Generally unwell | 1.49 (0.82–2.70), 0.19 | 1.69 (0.90–3.20), 0.11 | |
| (7) Placenta praevia | |||
| Anterior | 3.37 (0.86–13.30), 0.082 | 5.55 (1.29–23.9), 0.022 | |
| Major | 0.72 (0.17–3.05), 0.660 | 0.97 (0.22–4.25), 0.97 | |
| (8) Antepartum haemorrhage (APH) and urinary tract infection | |||
| APH | 1.26 (0.67–2.37), 0.48 | 1.25 (0.62–2.52), 0.53 | |
| ‘Warning APH’ | 1.70 (0.56–5.20), 0.35 | 1.99 (0.58–6.81), 0.27 | |
| (9) Pre-eclampsia (PET) and anaemia | |||
| Gestational hypertension | 1.00 (0.47–2.16), 0.99 | 0.98 (0.43–2.22), 0.97 | |
| Pre-eclampsia (PET) | 1.03 (0.43–2.50), 0.95 | 0.87 (0.32–2.13), 0.69 | |
| (10) Medications in pregnancy prebirth | |||
| Antibiotics | 1.02 (0.74–1.40), 0.91 | 0.95 (0.65–1.39), 0.79 | |
| Antihypertensives (including for PET) | 0.99 (0.56–1.78), 0.92 | 0.91 (0.49–1.70), 0.77 | |
| Diabetic Rx | 0.98 (0.44–2.18), 0.96 | 1.23 (0.52–2.91), 0.64 | |
| Steroids for fetal reasons | 2.00 (1.24–3.22), 0.004 | 2.00 (1.17–3.41), 0.011 | |
| (11) Gestation at birth | |||
| Gestation at delivery (weeks) | 0.95 (0.86–1.04), 0.25 | ||
| (12) Birthweight | |||
| Maximum birthweight (kg) | 1.17 (0.87–1.59), 0.30 | ||
| (13) Onset of labour | |||
| No labour onset | 1.28 (0.54–3.03), 0.58 | ||
| Induction | 1.07 (0.56–2.04), 0.83 | ||
| Augmentation | 1.37 (0.73–2.58), 0.33 | ||
| ROM >2 hours before onset | 1.01 (0.60–1.70), 0.96 | ||
| ROM >6 hours before onset | 1.16 (0.73–1.85), 0.52 | ||
| ROM unknown | 0.95 (0.52–1.73), 0.86 | ||
| (14) Intrapartum | |||
| Prostin | 1.12 (0.60–2.11), 0.73 | ||
| Syntocinon® | 0.75 (0.49–1.13), 0.17 | ||
| Spinal anaesthesia | 0.73 (0.45–1.18), 0.20 | ||
| Epidural analgesia | 1.20 (0.78–1.85), 0.41 | ||
| Raised temperature (per degree >37.0°C) | 1.21 (0.75–1.94), 0.44 | ||
| Temperature not recorded | 1.40 (0.86–2.27), 0.17 | ||
| Chorioamnionitis | 2.70 (0.70–10.5), 0.15 | ||
| (15) Birth | |||
| Instrumental vaginal | 0.79 (0.49–1.29), 0.36 | ||
| Elective caesarean | 0.14 (0.04–0.46), 0.001 | ||
| Emergency caesarean section | 0.34 (0.15–0.80), 0.013 | ||
| (16) Third stage | |||
| Physiological | 3.74 (1.72–8.10), 0.001 | ||
| Syntometrine® intramuscular | 1.12 (0.66–1.91), 0.68 | ||
| Syntocinon® intravenous bolus | 1.35 (0.63–2.87), 0.44 | ||
| Syntocinon® 40/50 IU infusion commenced | 0.97 (0.65–1.44), 0.87 | ||
| Retained placenta | 1.40 (0.77–2.54), 0.27 | ||
| Suture interval after vaginal birth (hours) | 1.16 (0.99–1.35), 0.058 | ||
| Suture interval not recorded | 0.44 (0.25–0.79), 0.006 | ||
Full regression model: result of three multiple regression models selecting the principal significant variables. In each model, a new additional group of predictors is used. Results are adjusted for other members of the same group and for previous groups only. Women with EBL <500 ml are excluded.