Grouping Parturients by Parity, Previous-Cesarean, and Mode of Delivery (P-C-MoD Classification) Better Identifies Groups at Risk for Postpartum Hemorrhage

Orna Reichman; Micahel Gal; Hen Y. Sela; Izzat Khayyat; Michael Emanuel; Arnon Samueloff

doi:10.1055/s-0036-1584579

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2016; 33(12): 1133-1137
DOI: 10.1055/s-0036-1584579

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Grouping Parturients by Parity, Previous-Cesarean, and Mode of Delivery (P-C-MoD Classification) Better Identifies Groups at Risk for Postpartum Hemorrhage

Orna Reichman

¹Division of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel

,

Micahel Gal

¹Division of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel

,

Hen Y. Sela

¹Division of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel

,

Izzat Khayyat

¹Division of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel

,

Michael Emanuel

¹Division of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel

,

Arnon Samueloff

¹Division of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel

› Institutsangaben

Abstract

Objective We aimed to create a clinical classification to better identify parturients at risk for postpartum hemorrhage (PPH).

Method A retrospective cohort, including all women who delivered at a single tertiary care medical center, between 2006 and 2014. Parturients were grouped by parity and history of cesarean delivery (CD): primiparas, multipara, and multipara with previous CD. Each were further subgrouped by mode of delivery (spontaneous vaginal delivery [SVD], operative vaginal delivery [OVD], emergency or elective CD). In all, 12 subgroups, based on parity, previous cesarean, and mode of delivery, formed the P-C-MoD classification. PPH was defined as a decrease of ≥3 gram% hemoglobin from admission and/or transfusion of blood products. Univariate analysis followed by multivariate analysis was performed to assess risk for PPH, controlling for confounders.

Results The crude rate of PPH among 126,693 parturients was 7%. The prevalence differed significantly among independent risk factors: primiparity, 14%; multiparity, 4%; OVD, 22%; and CD, 15%. The P-C-MoD classification, segregated better between parturients at risk for PPH. The prevalence of PPH was highest for primiparous undergoing OVD (27%) compared with multiparous with SVD (3%), odds ratio [OR] = 12.8 (95% confidence interval [CI],11.9–13.9). These finding were consistent in the multivariate analysis OR = 13.1 (95% CI,12.1–14.3).

Conclusion Employing the P-C-MoD classification more readily identifies parturients at risk for PPH and is superior to estimations based on single risk factors.

Keywords

postpartum hemorrhage - combined risk factors - clinical classification - parity

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Referenzen

References
1 AbouZahr C. Global burden of maternal death and disability. Br Med Bull 2003; 67: 1-11
2 Rath WH. Postpartum hemorrhage—update on problems of definitions and diagnosis. Acta Obstet Gynecol Scand 2011; 90 (5) 421-428
3 Steven G, Niebyl JR, Galan HL, Eric R, Jauniaux M, Landon MB, Simpson JL, Driscoll DA. Obstetrics: Normal and Problem Pregnancies. 6th Ed. Philadelphia, PA: Elsevier; 2012
4 Oyelese Y, Ananth CV. Postpartum hemorrhage: epidemiology, risk factors, and causes. Clin Obstet Gynecol 2010; 53 (1) 147-156
5 Dahlke JD, Mendez-Figueroa H, Maggio L , et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol 2015; 213 (1) 76.e1-76.e10
6 Rath WH. Postpartum hemorrhage—update on problems of definitions and diagnosis. Acta Obstet Gynecol Scand 2011; 90 (5) 421-428
7 Tourné G, Collet F, Lasnier P, Seffert P. Usefulness of a collecting bag for the diagnosis of post-partum hemorrhage [in French]. J Gynecol Obstet Biol Reprod (Paris) 2004; 33 (3) 229-234