title: Factors associated with acute postpartum hemorrhage in low-risk women delivering in rural India.
abstract: OBJECTIVE
  Postpartum hemorrhage (PPH), a major cause of maternal mortality and morbidity in low-income countries, can occur unpredictably. This study examined the sociodemographic, clinical, and perinatal characteristics of low-risk women who experienced PPH.
  
  
  METHODS
  This analysis was conducted using data on 1620 women from a randomized trial testing oral misoprostol for prevention of PPH in rural India.
  
  
  RESULTS
  Of the women, 9.2% experienced PPH. No maternal or sociodemographic factors and few perinatal factors differed between women with PPH and those without, other than treatment with misoprostol. Having fewer than 4 prenatal visits and lack of iron supplementation increased the risk for PPH (P<0.001 and P=0.037, respectively). Several factors unknown until the second stage of labor (perineal tear and birth weight) were also associated (P=0.003).
  
  
  CONCLUSIONS
  Among women at low risk for PPH, there were few factors associated with further risk. Given that PPH can occur without warning, rural communities should consider ways to increase both primary prevention (iron supplementation, AMTSL) and secondary prevention of PPH (availability of obstetric first aid, availability of transport, and availability of emergency obstetric care).
authors.affiliation: University of Illinois, Chicago College of Medicine, Chicago, IL, USA. SGeller@uic.edu
authors.forename: Stacie E
authors.initials: SE
authors.lastname: Geller
authors.forename: Shivaprasad S
authors.initials: SS
authors.lastname: Goudar
authors.forename: Marci G
authors.initials: MG
authors.lastname: Adams
authors.forename: Vijaya A
authors.initials: VA
authors.lastname: Naik
authors.forename: Ashlesha
authors.initials: A
authors.lastname: Patel
authors.forename: Mrutyunjaya B
authors.initials: MB
authors.lastname: Bellad
authors.forename: Shobhana S
authors.initials: SS
authors.lastname: Patted
authors.forename: Stanley A
authors.initials: SA
authors.lastname: Edlavitch
authors.forename: Nancy
authors.initials: N
authors.lastname: Moss
authors.forename: Bhalchandra S
authors.initials: BS
authors.lastname: Kodkany
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Derman
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008428:Maternal Mortality; D016595:Misoprostol / Q000008:administration & dosage; D010120:Oxytocics / Q000008:administration & dosage; D006473:Postpartum Hemorrhage / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D011247:Pregnancy; D011295:Prenatal Care; D012307:Risk Factors; D012424:Rural Population
chemical_list: D010120:Oxytocics; D016595:Misoprostol