ResearchObstetricsRisk factors for uterine atony/postpartum hemorrhage requiring treatment after vaginal delivery
Section snippets
Materials and Methods
We conducted a secondary analysis of a 3-arm double-blind randomized clinical trial of different doses of oxytocin.20 The primary aim of the trial was to evaluate higher doses of oxytocin compared to a standard low-dose oxytocin regimen used for prophylaxis among women undergoing vaginal delivery. Women were randomized to a 10- (standard), 40-, or 80-U dose regimen of oxytocin at vaginal delivery. Women were excluded if they were <24 weeks' gestation, underwent cesarean delivery, had fetal
Results
Our study sample included all 1798 women randomized and analyzed in the primary trial. In all, 658 women were randomized to 80 U of oxytocin, 481 women to 40 U (this arm was terminated at interim review), and 659 to 10 U of oxytocin. The distribution of the population according to characteristics under study is presented in Table 1. Of note, the dose of prophylactic oxytocin did not influence the outcome in the primary trial. The study population consisted of women who were predominantly obese,
Comment
Of 21 demographic and clinical factors examined, maternal race/ethnicity, preeclampsia, and chorioamnionitis were consistent risk factors for uterine atony or postpartum hemorrhage requiring treatment in our cohort of women who underwent vaginal delivery. When we applied a modified model selection strategy that emphasized strength of association over statistical significance, we identified additional risk factors. Prophylactic oxytocin doses did not influence the results as reported in the
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2023, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :A retrospective study showed that the AWHONN tool predicts hemorrhage related composite morbidity (hemorrhage, transfusion or ICU admission) [10]. The CMQCC, AWHONN and NYSBOH are widely used in the United States and are based on expert opinion with review of previous studies evaluating risk of PPH [11–19]. Multiple prediction models to identify patients at risk for PPH have been developed and validated (Table 1) [5].
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2023, MaturitasCitation Excerpt :Multiple gestation may be the result of ART, which has been associated with certain APOs [39] and can be indicative of underlying subfertility/infertility [29], a condition associated with earlier menopause [40] and CVD risk [41]. APOs and multiple gestation are known risk factors for postpartum hemorrhage [16,17] and treatment of this condition may disrupt blood flow to the ovaries [42,43]. Finally, there may be faster depletion of the ovarian follicle pool in women with multiple-gestation pregnancies due to a higher likelihood of hyper ovulation [44,45].
The authors report no conflict of interest.
Cite this article as: Wetta LA, Szychowski JM, Seals S, et al. Risk factors for uterine atony/postpartum hemorrhage requiring treatment after vaginal delivery. Am J Obstet Gynecol 2013;209:51.e1-6.