title: Risk of postpartum hemorrhage among Native American women.
abstract: OBJECTIVE
  To assess whether Native American women have an increased risk of postpartum hemorrhage (PPH) after vaginal delivery.
  
  
  METHODS
  In a retrospective study, medical charts were reviewed for patients who delivered vaginally at Rehoboth McKinley Hospital in Gallup, NM, USA, between June 1, 2009, and June 30, 2012. Ethnic origin had been determined by self-report. PPH was defined as a visually estimated blood loss of more than 500 mL. Multivariable logistic analysis was undertaken to identify factors independently associated with PPH.
  
  
  RESULTS
  Among 1062 eligible patients, 751 (70.7%) were Native American and 311 (29.3%) were non-native (white, African American, or Hispanic). A significantly higher proportion of Native Americans than non-native women developed PPH (87 [11.6%] vs 22 [7.0%]; P=0.02). In multivariable analysis, Native American ethnic origin was an independent predictor of PPH (odds ratio 1.8, 95% confidence interval 1.1-3.0; P=0.02). In a comparison with white women only, PPH was significantly more frequent among Native American women (87/751 [11.6%] vs 13/194 [6.7%]; P=0.01).
  
  
  CONCLUSIONS
  Native American women have a higher risk of PPH after vaginal delivery than do non-native women.
authors.affiliation: Department of Obstetrics and Gynecology, Rehoboth McKinley Christian Hospital, Gallup, NM, USA. Electronic address: salamchalouhy@gmail.com.
authors.forename: Salam E
authors.initials: SE
authors.lastname: Chalouhi
authors.affiliation: Department of Obstetrics and Gynecology, Rehoboth McKinley Christian Hospital, Gallup, NM, USA.
authors.forename: Jodi
authors.initials: J
authors.lastname: Tarutis
authors.affiliation: Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Barros
authors.affiliation: University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Mozurkewich
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D016015:Logistic Models; D015999:Multivariate Analysis; D009516:New Mexico / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology*; D011247:Pregnancy; D012189:Retrospective Studies; D012306:Risk; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Native American women; Postpartum hemorrhage; Pregnancy complications; Uterine atony; Vaginal delivery