A report published in September by researchers in Norway identifies several factors that can increase the risk of severe obstetric bleeding, blood loss of more than 1500 mL or the need for a blood transfusion. Knowledge of these potentially predictive risk factors is important because hemorrhage-related mortality is the most common cause of maternal deaths globally. The principal investigator of the study was Dr. Iqbal Al-Zirqi, Division of Obstetrics and Gynaecology, Rikshospitalet, Faculty of Medicine, University of Oslo, Norway.
In this large-scale study, Al-Zirqi and his colleagues analyzed data from 307,415 women who gave birth during a 5.3 year period, from January 1999 through April 2004. They discovered that 3,501, or 1.1%, of the women experienced severe obstetric bleeding. Study findings showed that the risk for severe obstetric hemorrhage was three times higher in women who underwent emergency cesarean delivery. Having von Willebrand disease also proved to be a noteworthy risk factor at 3.31%. Other predictive factors included elective caesarean delivery, multiple pregnancies and increased age. Mothers 40 years old and older were at considerably higher risk than those in their mid- to late 20s. According to Al-Zirqi and co-authors, these findings necessitate “a review of obstetric management procedures.”
Examination of the data also revealed that mothers of Southeast Asian ethnicity who were 30 years old or older were 77% more likely than European mothers to have severe obstetric bleeding. In contrast, mothers born in the Middle East had a rate that was 40% lower than that of Europeans.
Women who experienced severe hemorrhage were more likely to be admitted to hospital intensive care units. They had higher rates of postpartum sepsis, hysterectomy and acute renal failure. Maternal death rates were also higher in this group.
“Most of the identified risk factors were related to obstetric management and interventions, and are thus preventable,” concluded Al-Zirqi and co-authors. “Demographic and medical risk factors can be managed with extra vigilance.”
The report, “Prevalence and Risk Factors of Severe Obstetric Haemorrhage,” was published in the September 2008 issue of BJOG: An International Journal of Obstetrics & Gynaecology.
Source: Reuters, September 30, 2008