Table 2.
Clinical profile of women with severe postpartum hemorrhage versus controls
| Severe PPH (N = 1064) | Controls (N = 2059) |
OR | 95% CI | P -value | |
|---|---|---|---|---|---|
| Age (years) | |||||
| 14 – 19 | 12 (1.1%) | 13 (0.6%) | 2.23 | 0.96 – 5.17 | 0.061 |
| 20 – 24 | 60 (5.6%) | 145 (7.0%) | Ref. | ||
| 25 –29 | 240 (22.6%) | 507 (24.6%) | 1.14 | 0.82 – 1.60 | 0.435 |
| 30 –34 | 395 (37.1%) | 770 (37.4%) | 1.24 | 0.90 –1.71 | 0.194 |
| 35–39 | 283 (26.6%) | 501 (24.3%) | 1.36 | 0.98–1.91 | 0.068 |
| ≥40 | 74 (7.0%) | 123 (6.0%) | 1.45 | 0.96–2.21 | 0.078 |
| Parity | |||||
| 0 | 622 (58.5%) | 1007 (48.9%) | 1.54 | 1.30 – 1.82 | <0.001 |
| 1 | 296 (27.8%) | 738 (35.8%) | Ref. | ||
| 2 | 96 (9.0%) | 229 (11.1%) | 1.04 | 0.79 – 1.37 | 0.752 |
| ≥3 | 50 (4.6%) | 85 (4.1%) | 1.47 | 1.01 – 2.13 | 0.045 |
| Ethnicity | |||||
| Europe/USA/Oceania | 838 (78.8%) | 1682 (81.7%) | Ref. | ||
| Middle-East/North-Africa | 50 (4.6%) | 122 (5.9%) | 0.82 | 0.58 – 1.15 | 0.259 |
| Latin-America | 14 (1.3%) | 22 (1.1%) | 1.28 | 0.65 – 2.51 | 0.477 |
| Asia | 99 (9.3%) | 151 (7.3%) | 1.31 | 1.01 – 1.72 | 0.044 |
| Sub-Saharan Africa | 63 (5.9%) | 82 (4.0%) | 1.54 | 1.10 – 2.16 | 0.012 |
| BMI (kg/m2) | |||||
| <18.5 | 42 (4.0%) | 80 (3.9%) | 1.08 | 0.74 – 1.59 | 0.688 |
| 18.5 – 24.9 | 639 (60.1%) | 1317 (64.0%) | Ref. | ||
| 25.0 – 29.9 | 205 (19.3%) | 378 (18.4%) | 1.12 | 0.92 – 1.36 | 0.262 |
| 30.0 – 34.9 | 82 (7.7%) | 145 (7.0%) | 1.16 | 0.87 – 1.55 | 0.295 |
| 35.0 – 39.9 | 25 (2.4%) | 36 (1.8%) | 1.43 | 0.85 – 2.40 | 0.176 |
| ≥40 | 7 (0.7%) | 14 (0.7%) | 1.03 | 0.41 – 2.56 | 0.949 |
| Married/cohabitant | 973 (91.4%) | 1932 (94.1%) | 0.70 | 0.53 – 0.93 | 0.014 |
| Pre-pregnancy conditions | |||||
| Uterine anomaly | 16 (1.5%) | 13 (0.6%) | 2.40 | 1.15 – 5.01 | 0.020 |
| Uterine surgery | 19 (1.8%) | 11 (0.5%) | 3.38 | 1.60 – 7.14 | 0.001 |
| Previous cesarean | 126 (11.8%) | 221 (10.7%) | 1.12 | 0.88 – 1.41 | 0.350 |
| Previous severe PPH | 66 (6.2%) | 21 (1.0%) | 6.42 | 3.90 – 10.6 | <0.001 |
| Obstetric factors | |||||
| Multiple pregnancy | 94 (8.8%) | 52 (2.5%) | 3.74 | 2.64 – 5.29 | <0.001 |
| IVF/ICSI | 115 (10.8%) | 82 (4.0%) | 2.92 | 2.18 – 3.92 | <0.001 |
| Anemia (Hb ≤ 9.0 g/dL) | 74 (7.0%) | 38 (1.9%) | 4.11 | 2.76 – 6.13 | <0.001 |
| Gestational diabetes mellitus | 46 (9.4%) | 58 (2.8%) | 1.56 | 1.05 – 2.31 | 0.027 |
| Uterine fibroma | 52 (4.9%) | 38 (1.9%) | 2.73 | 1.79 – 4.18 | <0.001 |
| Polyhydramnios | 16 (1.5%) | 12 (0.6%) | 2.60 | 1.23 – 5.52 | 0.013 |
| Anticoagulant medication | 51 (4.8%) | 22 (2.1%) | 4.66 | 2.81 – 7.73 | <0.001 |
| Severe pre-eclampsia or HELLP syndrome |
50 (4.7%) | 28 (2.6%) | 3.58 | 2.24 – 5.71 | <0.001 |
| Intrapartum factors | |||||
| Mode of delivery | |||||
| Spontaneous vaginal | 507 (47.6%) | 1358 (66.0%) | Ref. | ||
| Instrumental vaginal | 212 (20.0%) | 25 (12.2%) | 2.26 | 1.83 – 2.79 | <0.001 |
| In-labor cesarean | 248 (23.3%) | 245 (11.9%) | 2.71 | 2.21 – 3.32 | <0.001 |
| Elective cesarean | 97 (8.6%) | 205 (10.0%) | 1.27 | 0.97 – 1.65 | 0.077 |
| PROM | 127 (12.0%) | 169 (8.2%) | 1.51 | 1.19 – 1.93 | 0.001 |
| Fever (temp > 38 °C) in labor | 75 (7.1%) | 60 (2.9%) | 2.53 | 1.78 – 3.58 | <0.001 |
| Labor augmentation | 587 (55.2%) | 797 (38.7%) | 1.95 | 1.68 – 2.26 | <0.001 |
| Labor induction | 349 (32.8%) | 402 (19.5%) | 2.01 | 1.70 – 2.38 | <0.001 |
| Birth weight > 4500 g | 51 (4.8%) | 57 (2.8%) | 1.77 | 1.20 – 2.60 | 0.004 |
Data presented as n (%), odds ratio (OR) and 95% confidence intervals (CI)
BMI body mass index, Hb hemoglobin, IVF/ICSI in vitro fertilization/intra-cytoplasmic sperm injection, HELLP hemolysis, elevated liver enzymes, low platelet count, PROM premature rupture of membranes, PPH postpartum hemorrhage