title: Predictors of severity in primary postpartum hemorrhage.
abstract: OBJECTIVE
  To identify risk factors and etiologies leading to severe primary postpartum hemorrhage (PPH) in women with PPH.
  
  
  METHODS
  Women who experienced PPH within the first 24 h after delivery over a 3-year period were retrospectively evaluated. Patients were divided into two groups on the basis of severe PPH (n = 125) or non-severe PPH (n = 411). Risk factors and etiologies for severe PPH were explored using univariate and multivariate logistic regression analyses.
  
  
  RESULTS
  PPH and severe PPH complicated 2.1 and 0.49 % of all deliveries, respectively. Previous cesarean delivery (OR = 3.15, 95 % CI = 1.02-10.3; p = 0.001), prolonged labor (OR = 3.62, 95 % CI = 3.21-4.03; p < 0.001), oxytocin augmentation (OR = 3.32, 95 % CI 2.05-5.93; p < 0.001) and emergency cesarean delivery (OR = 4.75, 95 % CI 1.32-12.96; p < 0.001) were the factors independently associated with severe PPH. Etiologies significantly associated with severe PPH are uterine atony (OR = 2.72, 95 % CI 1.64-4.55; p < 0.001) and abnormal placentation (OR = 3.05, 95 % CI 1.56-6.27; p = 0.006).
  
  
  CONCLUSIONS
  Previous cesarean delivery, prolonged labor, oxytocin augmentation and emergency cesarean delivery are strongest predictors of severe blood loss in women with PPH. In addition, uterine atony and abnormal placentation are the etiologies significantly associated with severe PPH.
authors.affiliation: Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey. atalayekin@hotmail.com.
authors.forename: Atalay
authors.initials: A
authors.lastname: Ekin
authors.affiliation: Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors.forename: Cenk
authors.initials: C
authors.lastname: Gezer
authors.affiliation: Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors.forename: Ulas
authors.initials: U
authors.lastname: Solmaz
authors.affiliation: Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors.forename: Cuneyt Eftal
authors.initials: CE
authors.lastname: Taner
authors.affiliation: Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors.forename: Askin
authors.initials: A
authors.lastname: Dogan
authors.affiliation: Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozeren
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D008423:Maternal Age; D015999:Multivariate Analysis; D010121:Oxytocin / Q000009:adverse effects; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D011295:Prenatal Care; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014593:Uterine Inertia; D055815:Young Adult
chemical_list: D010121:Oxytocin
keywords: Emergency cesarean delivery; Perinatal outcome; Placenta accreta; Primary postpartum hemorrhage; Prolonged labor; Uterine atony