Postpartum hemorrhage after cesarean delivery: an analysis of risk factors.
OBJECTIVE
To determine the incidence and risk factors for postpartum hemorrhage (PPH) associated with cesarean delivery.


METHODS
Blood loss at cesarean delivery was measured and defined as 1,000 to 1,499 mL or greater than 1,500 mL and/or the need for a blood transfusion. Variables were identified and evaluated to determine the factors associated with PPH.


RESULTS
There were 1,844 elective and 2,993 nonelective cesarean deliveries over 4 years. The PPH rate in nonelective cesarean (6.75%) was greater than after elective cesarean (4.84%, P = 0.007). Risk factors for PPH after an elective operation included leiomyomata, blood disorders, placenta previa, antepartum bleeding, preterm birth, and general anesthesia. Nonelective cesarean PPH risk factors included blood disorders, retained placenta, antepartum transfusion, antepartum/intrapartum hemorrhage, placenta previa, general anesthesia, and macrosomia (odds ratio > 1.5, confidence interval > 1.5).


CONCLUSIONS
Nonelective cesarean deliveries have a higher risk of PPH than women delivered electively. Risk factor identification and prevention should be a priority.
Magann
Everett F
EF
School of Women and Infants Health, King Edward Memorial Hospital, Perth, Australia.
Evans
Sharon
S
Hutchinson
Maureen
M
Collins
Robyn
R
Lanneau
Grainger
G
Morrison
John C
JC
D000328:Adult; D016063:Blood Loss, Surgical; D001810:Blood Volume; D002585:Cesarean Section / Q000009:adverse effects*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D010298:Parity; D006473:Postpartum Hemorrhage / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications; D012307:Risk Factors