Table 2. Non-infectious diseases in the puerperium (excluding hypertensive disorders and thrombosis/embolism): incidences and risk factors.
| Disease and symptoms | Incidence (relative to overall birth numbers) | Risk factors aOR/OR [95% confidence interval], references |
| Uterine subinvolution Atonic postpartum hemorrhage Delayed uterine atony (> 24 h postpartum) Symptoms see Text and Table 1 |
Uterine subinvolution: common (Atony see Table 1 “Potentially life-threatening diseases”) |
General risk factors for atonic postpartum hemorrhage: Status post severe atonic postpartum hemorrhage aOR 8.97 [5.25; 15.33] (36) Placenta previa or premature placental separation aOR 7.0 [6.6; 7.3] (36) Uterine rupture aOR, 11.6 [9.7; 13.8] (39) Cervical tear aOR 94.0 [87.3; 101.2] (39) Anticoagulant medication aOR 4.79 [2.72; 8.41] (36) Anemia on admission to the maternity unit aOR 4.27 [2.79; 6.54] (36) Severe pre-eclampsia or HELLP aOR 3.03 [1.74; 5.27] (36)to 3.1 [2.9; 3.3] (39) Chorionamnionitis aOR 2.9 [2.5; 3.4] (39) Uterine fibroids aOR 2.0 [1.8; 2.2] (39) to 2.71 [1.69; 4.35] (36) Multiple birth aOR 2.11 [1.39; 3.22] (35) to 2.8 [2.6; 3.0] (39) Assisted reproduction aOR 1.88 [1.33; 2.65] (36) Secondary cesarean section aOR 1.95; [1.53; 2.47] (35); Cesarean section in general aOR 1.4 [1.3; 1.5] (39) Operative vaginal delivery aOR 1.5 [1.17; 1.93] (36); aOR 1.5 [1.4; 1.6] (39) Induction of labor aOR 1.69 [1.39; 2.05] (36) Augmentation of labor aOR 1.59 [1.32; 1.91) (36) Specific risk factors for delayed uterine atony: Delayed uterine atony (previous pregnancy) OR 6.0 [2.1; 16.8] (e21) Status post early uterine atony (current pregnancy) OR 4.7 [1.9; 11.6] (e21) Vaginal bleeding before 24 weeks gestational age OR 3.0 [1.6; 5.9] (e21) Prolonged econd stage of labour OR 3.1 [1.2; 7.5] (e21) Arrested labor during econd stage of labour OR 2.1 [1.0; 4.2] (e21) |
| Urinary incontinence | Prevalence for all women > 20 years: 20% (Norway, population-based) (19) After cesarean section 15.9% Following vaginal birth 21.0% (at any time) (19) 3 Months postpartum in general: 24% (17) to 29% (18) 20 years after vaginal birth 40.3% and after cesarean section 28.8% (20) |
Vaginal birth aOR 2.3 [2.0; 2.6] compared to nulliparous women and 1.7 [1.3; 2.1] compared to cesarean section (19) Cesarean section: aOR 0.28 [0.19; 0.41] (18) to OR 0.54 [0.43; 0.68] (17) compared to vaginal birth, and aOR 1.5 [1.2; 1.9] compared to nulliparous women (19) Maternal age ≥ 35 OR 2.02 [1.35; 3.02] (18) |
| Urinary retention > 6 hours postpartum | 0.45–0.7% (e58– e60) | |
| Urinary retention (increased residual urine >= 100 ml) | Data vary widely: 1.5–47% (e62, e63) |
Protracted expulsion period (>10 h), operative vaginal delivery, episiotomy OR 1.7 [1.02; 2.71] (22), high birth weight OR 1.03 [1.01; 1.06] (22), EPA OR 2.08 [1.36; 3.19] (22) |
| Postpartum thyroiditis | 1–16.7% (e69– e82) |
Anti-TPO Ab detection RR 5.7 [5.3; 6.1] (e86) In persistent anti-TPO Ab in the 3rd trimester, incidence > 80 % (34, 35, e88), compared to 2% in anti-TPO Ab-negative women (e89) Type 1 diabetes mellitus: incidence 10.5 % (e84) to 25 % (e85) (19.6% [19.5; 19.7] (e83) and 25 % [12.7; 41.2] (e86) compared to 8.8% in non-diabetics (e86) |
| Sheehan’s syndrome | Rare in industrialized countries (e.g., 5/100,000 in Iceland (e115) Likely to be more common in the case of poor healthcare (e.g., 3% of all women > 20 years in an Indian study (e116) |
(Insufficiently treated) hemorrhagic shock (e92) |
aOR, adjusted odds ratio; anti-TPO Ab, anti-thyroid peroxidase autoantibodies; HELLP, hemolysis, elevated liver enzymes, low levels of platelets; OR, odds ratio; EPA, epidural anesthesia; RR, relative risk; GW, gestational week