American Journal of Obstetrics & Gynecology
Volume 201, Issue 3 , Pages 273.e1-273.e9, September 2009

Effects of onset of labor and mode of delivery on severe postpartum hemorrhage

  • Iqbal Al-Zirqi, MD, MRCOG

      Affiliations

    • Division of Obstetrics and Gynecology, Faculty of Medicine, University of Oslo, Rikshospitalet, Oslo, Norway
    • Corresponding Author InformationReprints: Iqbal Al-Zirqi, MD, University of Oslo, Division of Obstetrics and Gynecology, Sognsvannsvn 20, Rikshospitalet, Oslo 0027 Norway
    • ,
  • Siri Vangen, MD, PhD

      Affiliations

    • Division of Obstetrics & Gynecology, National Resource Center for Women's Health, Rikshospitalet, Oslo, Norway
    • ,
  • Lisa Forsén, PhD, MSc

      Affiliations

    • Norwegian Institute of Public Health, Rikshospitalet, Oslo, Norway
    • ,
  • Babill Stray-Pedersen, MD, PhD

      Affiliations

    • Division of Obstetrics & Gynecology, Faculty of Medicine, University of Oslo, Rikshospitalet, Oslo, Norway

Received 13 November 2008; received in revised form 20 March 2009; accepted 1 June 2009.

Objective

Our purpose was to study the impact of labor onset and delivery mode on the risk of severe postpartum hemorrhage.

Study Design

This was a population-based study of 307,415 mothers who were registered in the Medical Birth Registry of Norway from 1999-2004.

Results

Severe postpartum hemorrhage occurred in 1.1% of all mothers and in 2.1% of those mothers with previous cesarean section delivery (CS). Compared with spontaneous labor, hemorrhage risk was higher for induction (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.56–1.88) and prelabor CS (OR, 2.05; 95% CI, 1.84–2.29). The risk was 55% higher for emergency CS and half that for vaginal deliveries (OR, 0.48; 95% CI, 0.43–0.53), compared with prelabor CS. The highest risk was for emergency CS after induction in mothers with previous CS (OR, 6.57; 95% CI, 4.25–10.13), compared with spontaneous vaginal delivery in mothers with no previous CS.

Conclusion

Induction and prelabor CS should be practiced with caution because of the increased risk of severe postpartum hemorrhage.

Key words: delivery mode, emergency CS, labor onset, prelabor CS, severe postpartum hemorrhage

 

 This study was supported by the Norwegian Foundation for Health and Rehabilitation and the Norwegian Women's Public Health Association.

 Cite this article as: Al-Zirqi I, Vangen S, Forsén L, et al. Effects of onset of labor and mode of delivery on severe postpartum hemorrhage. Am J Obstet Gynecol 2009;201:273.e1-9.

PII: S0002-9378(09)00627-9

doi:10.1016/j.ajog.2009.06.007

American Journal of Obstetrics & Gynecology
Volume 201, Issue 3 , Pages 273.e1-273.e9, September 2009