Risks for peroperative excessive blood loss in cesarean delivery

Acta Obstet Gynecol Scand. 2010 May;89(5):658-63. doi: 10.3109/00016341003605727.

Abstract

Objective: To analyze risk factors for peroperative excessive blood loss at cesarean delivery.

Design: Case-control study.

Setting: Twenty-four of 26 maternity units in Norway with at least 500 expected deliveries per year.

Sample: A total of 2,778 women having singleton deliveries and participating in the Norwegian Breakthrough Project on Cesarean Section.

Methods: Elective and emergency operations were analyzed separately with extensive blood loss defined as hemorrhage > 1000 ml with controls defined as bleeding < 500 ml. All analyzes were done in SPSS (version 16.0) with chi-squared tests and logistic regression.

Main outcome measures: Adjusted odds ratios (aOR) of extensive peroperative bleeding.

Results: The prevalence of excessive blood loss differed between women undergoing elective (2.1%) and emergency cesarean deliveries (3.3%). Among maternal factors, chronic maternal diseases, pregnancy and delivery related conditions, placenta previa (aOR 19.7; 95% CI 5.4-72.2) and transverse lie (aOR 4.9; 95% CI 0.9-26.5) were the only risk factors for extensive blood loss in elective operations, whereas placenta previa (aOR 8.4; 95% CI 2.4-29.9), placental abruption (aOR 2.0; 95% CI 2.0-14.5), intervention at full cervical dilation (aOR 3.2; 95% CI 1.4-7.1) and high BMI (aOR 3.4; 95% CI 1.6-7.2) were risks in emergency operations.

Conclusion: The different risk pattern for excessive bleeding in cesarean deliveries should be recognized when planning available obstetric competence for surgery.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Blood Loss, Surgical / statistics & numerical data*
  • Case-Control Studies
  • Cesarean Section / adverse effects*
  • Cesarean Section / methods
  • Cesarean Section / statistics & numerical data*
  • Chi-Square Distribution
  • Confidence Intervals
  • Elective Surgical Procedures
  • Emergency Treatment
  • Female
  • Follow-Up Studies
  • Gestational Age
  • Humans
  • Logistic Models
  • Middle Aged
  • Obstetric Labor Complications / epidemiology*
  • Obstetric Labor Complications / etiology
  • Obstetric Labor Complications / surgery
  • Odds Ratio
  • Perioperative Care
  • Postpartum Hemorrhage / epidemiology*
  • Postpartum Hemorrhage / etiology
  • Pregnancy
  • Pregnancy Outcome*
  • Prevalence
  • Probability
  • Reference Values
  • Risk Assessment
  • Severity of Illness Index