Z Geburtshilfe Neonatol 2017; 221(S 01): E1-E113
DOI: 10.1055/s-0037-1607666
Vorträge
Klinisch praktische Geburtshilfe I
Georg Thieme Verlag KG Stuttgart · New York

Is induction of labor associated with postpartum hemorrhage?

R Brun
1   Universitätsspital Zürich, Geburtshilfe, Zürich, Switzerland
,
E Spoerri
2   Universität Zürich, Zürich, Switzerland
,
L Schäffer
3   Kantonsspital Baden, Geburtshilfe, Baden, Switzerland
,
R Zimmermann
1   Universitätsspital Zürich, Geburtshilfe, Zürich, Switzerland
,
C Haslinger
1   Universitätsspital Zürich, Geburtshilfe, Zürich, Switzerland
› Author Affiliations
Further Information

Publication History

Publication Date:
27 October 2017 (online)

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Objective:

The aim of our study was to compare blood loss after delivery in women with induction of labor (IOL) to women with spontaneous onset of labor in a prospective cohort study.

Methods:

In the University Hospital of Zurich, 965 deliveries were analyzed including 380 women with IOL (39.3%) between 2015 – 2016. Parameters of increased postpartum bleeding such as incidence of postpartum hemorrhage (PPH), estimated blood loss (EBL) and delta hemoglobin (ΔHb, difference between prepartum and postpartum Hb) were compared between the two groups. In a multivariate linear regression analysis the effect of the established obstetric risk factors for PPH on delta hemoglobin was evaluated. In a subgroup analysis, women with a duration of IOL of more than 48 hours were compared to women without IOL. A p value < 0.01 was considered statistically significant due to multiple testing.

Results:

Incidence of PPH and EBL were not significantly different in women with IOL compared to those without IOL (24.7% vs. 21.2%, p = 0.20; and 400 (300 – 600)ml vs. 400 (300 – 500)ml, p = 0.03). Women with IOL had a significantly lower drop in hemoglobin after delivery (ΔHb 13 (5 – 21)g/l vs. 16 (9 – 24)g/l, p < 0.01). Clinical relevant loss of hemoglobin defined as ΔHb ≥30 g/l did not differ (12.9% vs. 13.8%, p = 0.67). In the multivariate linear regression analysis, induction of labor remains associated with decreased loss of hemoglobin after delivery (ΔHb -3.9 g/l (CI 95% -4.98 to -1.79 g/l), p < 0.01). Women with more than 48 hours of IOL had higher EBL after delivery as compared to women without IOL (500 (388 – 800)ml vs. 400 (300 – 500)ml, p < 0.01) but comparable incidence of PPH (28.9% vs. 21.2%, p = 0.26) and ΔHb (17 (7.75 – 30)g/l vs. 16 (9 – 24)g/l, p = 0.56).

Conclusions:

Induction of labor is not associated with increased postpartum hemorrhage. In fact, women with IOL show a statistically significant, however clinically not relevant lower loss of hemoglobin after delivery as compared to women with spontaneous onset of labor.