Risk factors for post-partum hemorrhage following vacuum assisted vaginal delivery.
OBJECTIVE
To identify risk factors for post-partum hemorrhage (PPH) following vacuum assisted vaginal delivery (VAVD).


METHODS
A retrospective study of all women with singleton pregnancies who underwent VAVD in a tertiary hospital (2012-2014). PPH was defined as any of the following: ≥500 ml estimated blood loss, hemoglobin drop ≥3 g/dl (difference between pre- and post-VAVD hemoglobin levels) or the need for blood products transfusion. Characteristics of women with PPH following VAVD were compared to those of women with no PPH following VAVD.


RESULTS
Of 1,154 VAVDs, 295 (25.6 %) had PPH. Women in the PPH group were more often nulliparous (83.1 vs. 70.5 %, p = 0.001) and had higher rate of hypertensive disorders (4.4 vs. 1.4 %, p = 0.001). The rate of episiotomy (87.8 vs. 81.6 %, p = 0.01) was higher in the PPH group. In multivariate analysis, risk factors for PPH were (Odds Ratio, 95 % Confidence Interval) hypertensive disorders (2.40, 1.03-5.58, p = 0.04), induction of labor (1.42, 1.01-2.10, p = 0.04) and longer second (1.003, 1.001-1.006, p = 0.03) and 3rd (1.02, 1.01-1.04, p = 0.004) stages of labor.


CONCLUSIONS
Risk factors for PPH following VAVD can be identified and should be taken into consideration at the immediate post-partum period.
Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach Tikva, Israel. lirhir@gmail.com.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. lirhir@gmail.com.
Liran
L
Hiersch
Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Riki
R
Bergel-Bson
Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Dorit
D
Asher
Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Amir
A
Aviram
Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Rinat
R
Gabby-Benziv
Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Yariv
Y
Yogev
Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eran
E
Ashwal
D000328:Adult; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage / Q000209:etiology* / Q000473:pathology; D049590:Postpartum Period; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects*
Induction of labor; Post-partum hemorrhage; Risk factors; Vacuum assisted vaginal delivery