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Created on : 03 Nov 2004
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Bibliographical entry (without author) :

Risk factors for major obstetric haemorrhage. Eur J Obstet Gynecol Reprod Biol 1993; 48 : 15-8.

Author(s) :

Stones RW, Paterson CM, Saunders NJ.

Year of publication :

1993

URL(s) :

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=…

Résumé (français)  :

Les facteurs associés à une hémorragie importante ont été étudiés rétrospectivement pour 37497 accouchements en 1988 (National Health Service maternity units in the North West Thames Region, Royaume-Uni). Il y a eu 498 cas (1.33%) compliqués par un saignement d’au moins 1000 millilitres.

Les facteurs intrinsèques associés à des risques importants (intervalles de confiance à 99%) comprennent la rupture placentaire (facteur de risque 12.6, intervalle 7.61-20.9), le placenta praevia (13.1, 7.47-23.0), la grossesse multiple (4.46, 3.01-6.61) et l’obésité (1.64, 1.24-2.17), mais pas la multiparité.

Les risques significatifs pour ce qui concerne le traitement obstétrical comprennent la rétention placentaire (5.15, 3.36-7.87), le déclenchement du travail (2.22, 1.67-2.96), l’épisiotomie (2.06, 1.36-3.11) et un poids de naissance supérieur à 4 kg (1.90, 1.38-2.60). Par contre, pas de résultat significatif pour les déchirures (1.41, 0.01-2.18).

Parmi les 59 femmes qui ont perdu au moins 1000 ml de sang et ont acouché vaginalement avec un périnée intact, les facteurs de risque significatifs (intervalles de confiance à 99%) étaient la rétention placentaire (13.7, 5.92-31.8) et le déclenchement du travail (2.35, 1.11-4.98).

Abstract (English)  :

The factors associated with major obstetric haemorrhage were analyzed using data relating to 37,497 women delivered in 1988 in National Health Service maternity units in the North West Thames Region, UK. Four hundred ninety-eight cases (1.33%) were complicated by haemorrhage of 1000 ml or more.

Intrinsic factors associated with significant risk ratios (99% confidence intervals) included placental abruption 12.6 (7.61-20.9), placenta praevia 13.1 (7.47-23.0), multiple pregnancy 4.46 (3.01-6.61) and obesity 1.64 (1.24-2.17), but not high parity.

Significant risk factors related to obstetric management and delivery included retained placenta 5.15 (3.36-7.87), induced labour 2.22 (1.67-2.96), episiotomy 2.06 (1.36-3.11) and birthweight 4 kg or more 1.90 (1.38 to 2.60).

Among the 59 women who lost 1000 ml or more in association with a spontaneous vaginal delivery with an intact perineum, significant risk ratios (99% confidence intervals) were retained placenta 13.7 (5.92-31.8) and induced labour 2.35 (1.11-4.98).

These data provide a more comprehensive assessment of risk factors for potentially life threatening haemorrhage in British obstetric practice than is possible using maternal mortality statistics. The hazards of well known factors such as multiple pregnancy, abruption, placenta praevia and caesarean delivery were confirmed but attention is drawn to the potential risk of haemorrhage associated with obesity or a large baby and to that associated with retained placenta in women classified as ’low risk’.

(Department of Obstetrics and Gynaecology, St Mary’s Hospital Medical School, London, UK.)

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Keywords :

➡ placenta previa/accreta ; postpartum hemorrhage ; episiotomy ; induction of labor ; post-term pregnancy

Author of this record :

Bernard Bel — 03 Nov 2004