title: Is there an increase of postpartum hemorrhage, and is severe hemorrhage associated with more frequent use of obstetric interventions?
abstract: OBJECTIVE
  To analyze changes in postpartum hemorrhage over a 10-year period from 1998 to 2007, and to explore factors associated with severe hemorrhage.
  
  
  METHODS
  Retrospective cohort study, prospectively collected information.
  
  
  METHODS
  Stavanger University Hospital, a secondary referral center, Norway.
  
  
  METHODS
  An unselected population of 41,365 women giving birth at the hospital.
  
  
  METHODS
  We analyzed changes over time in mean postpartum hemorrhage, severe postpartum hemorrhage and associated factors. Estimated blood loss >1,000 ml was defined as severe hemorrhage. Data were collected from the hospital's database.
  
  
  METHODS
  Severe postpartum hemorrhage and obstetric interventions.
  
  
  RESULTS
  We observed an increase in severe hemorrhage during the study period. After cesarean sections, the risk of severe hemorrhage was twice the risk of severe hemorrhage after vaginal deliveries (5.9%; 95% CI 5.3-6.6 vs. 2.8%; 95% CI 2.6-2.9). The most important factors associated with severe hemorrhage following vaginal deliveries were twin deliveries (OR 6.8), retained placenta (OR 3.9) and inductions of labor (OR 2.2). For cesarean sections, twin deliveries had the strongest association with severe hemorrhage (OR 3.7) followed by general anesthesia (OR 3.0). Obstetric interventions became more frequent; elective cesarean sections increased from 2.4 to 4.9%, acute cesarean sections from 5.5 to 8.9%, operative vaginal deliveries from 9.3 to 12.5%, inductions of labor from 14.3 to 15.8% and augmentations of labor from 5.8 to 29.3%.
  
  
  CONCLUSIONS
  The incidence of severe postpartum hemorrhage increased, and this may be related to more frequent use of obstetric interventions.
authors.affiliation: Department of Obstetrics and Gynecology, Stavanger University Hospital, Norway. janne.rossen@gmail.com
authors.forename: Janne
authors.initials: J
authors.lastname: Rossen
authors.forename: Inger
authors.initials: I
authors.lastname: Okland
authors.forename: Odd Bjarte
authors.initials: OB
authors.lastname: Nilsen
authors.forename: Torbjørn M
authors.initials: TM
authors.lastname: Eggebø
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D009664:Norway; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D012189:Retrospective Studies