title: Risk Factors for Severe Secondary Postpartum Hemorrhages: A Historical Cohort Study.
abstract: BACKGROUND
  The predictive factors of secondary postpartum hemorrhage (PPH) are little known. Our principal objective was to determine if immediate PPH is a risk factor for severe secondary PPH. We also sought to identify other factors associated with severe secondary PPH.
  
  
  METHODS
  Our historical cohort study included all women who gave birth (≥ 22 weeks) in our level III hospital from 2004 through 2013. The hospital discharge database enabled us to identify all women readmitted during the 42-day postpartum period or who underwent a surgical, medical, or interventional radiology procedure during their immediate postpartum hospitalization. We then examined all medical records to identify the cases involving severe secondary PPH. We studied the known risk factors of secondary PPH and assessed other potential ones: maternal age, multiple pregnancy, induction of labor, cesarean birth, preterm birth, and stillbirth.
  
  
  RESULTS
  The study included 63 women with a severe secondary PPH and 25,696 women without a secondary PPH. Immediate PPH (aOR 2.7 [95% CI 1.3-5.6]) and maternal age ≥ 35 years (aOR 2.0 [95% CI 1.1-3.7]) were the only factors associated with severe secondary PPH.
  
  
  CONCLUSIONS
  This cohort study confirms that immediate PPH is a risk factor for severe secondary PPH and reports for the first time an association between secondary PPH and advanced maternal age. It is likely that risk factors for immediate PPH are also risk factors for severe secondary PPH and thus that immediate PPH may be an intermediate factor between its own known risk factors and secondary PPH.
authors.affiliation: Department of Public Health, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, EA, France.|PEPRADE, University of Auvergne, Clermont-Ferrand, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Debost-Legrand
authors.affiliation: AUDIPOG Sentinel Network, medical university RTH Laennec, Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Rivière
authors.affiliation: Department of Obstetrics & Gynecology, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Dossou
authors.affiliation: Department of Public Health, Department of Obstetrics & Gynecology, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, EA, France.|PEPRADE, University of Auvergne, Clermont-Ferrand, AUDIPOG Sentinel Network, medical university RTH Laennec, Lyon, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Vendittelli
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005602:France; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric / Q000097:blood*; D008423:Maternal Age; D036801:Parturition / Q000097:blood*; D006473:Postpartum Hemorrhage / Q000209:etiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D055815:Young Adult
keywords: birth; maternal morbidity; secondary postpartum hemorrhage