title: [Incidence and factors related to excessive intrapartum blood loss].
abstract: BACKGROUND
  Childbirth and postpartum carry a high potential risk to the woman, with bleeding being a major cause of morbidity and mortality. A drop in haemoglobin ≥ 3.5 g during the delivery process is considered as excessive bleeding, and is used as an indicator of quality of care in childbirth.
  
  
  OBJECTIVE
  To determine the incidence and factors associated with excessive intrapartum blood loss.
  
  
  METHODS
  Hybrid design nested case-control study was performed in a cohort of 1488 pregnant women who gave birth at the Hospital La Mancha-Centro in 2008. We selected all the cases (84 subjects with a haemoglobin loss of ≥ 3.5 g) and twice the number of controls (164) matched by time of delivery. Multivariate analysis was performed using conditional logistic regression.
  
  
  RESULTS
  The incidence of excessive intrapartum bleeding was 6.6%, with no significant differences regarding the mode of delivery (Vaginal and Caesarean=6.8%=5.6%). Antepartum anaemia was around 10% and postpartum anaemia 41.4%. We found no factors associated with bleeding in Caesarean deliveries. However, in the vaginal primiparity, manual removal and particularly the practice of episiotomy [OR=4.82 (95% CI, 1.73 to 13.44] are presented as clear risk factors.
  
  
  CONCLUSIONS
  The incidence of excessive bleeding is above recommended levels. Primiparity, manual removal and particularly episiotomy are risk factors for bleeding.
authors.affiliation: Atención Primaria, Área de Salud, Alcázar de San Juan, Ciudad Real, España. anaisabel.alcazar@gmail.com
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: Romero-Arias
authors.forename: María
authors.initials: M
authors.lastname: Luján-Prior
authors.forename: Jonathan
authors.initials: J
authors.lastname: Pernia-Fernández
authors.forename: Antonio
authors.initials: A
authors.lastname: Hernández-Martínez
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D006473:Postpartum Hemorrhage / Q000453:epidemiology*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors