We selected deliveries that were induced or had spontaneous onset, and found that PPH due to placental abruption and placenta previa represented a small proportion (2%) of all PPH registrations, and these were therefore not included in Tables 3– 5. Table 3 shows risks of PPH types according to maternal, pregnancy and birth characteristics. The opposite was found for PPH caused by retained placenta, where 26% of the placentas were defined as normal. Placenta was defined as “normal” (tic box) in most deliveries with PPH without defined cause, in PPH due to obstetric trauma, and due to dystocia (75–85%). Women who experienced PPH due to retained placenta or atony were more likely delivering girls than boys, while those with PPH caused by dystocia, obstetric trauma and undefined bleeding cause were more often delivering boys. High birthweight was commonly found in PPH caused by dystocia, atony and obstetric trauma.Ī history of first trimester bleeding was more common in women with PPH due to placenta previa (6.1%) and retained placenta (4.8%), while the opposite was the case for PPH caused by obstetric trauma (1.9%). Smoking was more common in PPH associated with placenta previa and placental abruption.ĭiabetes mellitus was more common in PPH associated with dystocia (4.2%), while preeclampsia was more common in PPH associated with placental abruption (8.0%). Young women were more often registered with PPH due to obstetric trauma, and women with PPH caused by dystocia and obstetric trauma were more often nulliparous. Distribution of maternal, pregnancy and birth characteristics in types of postpartum hemorrhage (PPH >500ml) singleton births, ≥22 weeks of gestation. Thus, we aimed to explore risk profiles of different PPH types through our specific objectives: to calculate the effects of demographic and pregnancy-related factors, obstetric history and complications related to the fetus, placenta, membranes and umbilical cord, and to investigate the recurrence risk of the different types of PPH in the Norwegian population. Studies have reported associations of PPH (in general) with demographic, and pregnancy-related factors, induction of labor, obstetric history, including recurrence risk, and complications related to the fetus, placenta, membranes and umbilical cord, while studies on risk factors of type specific PPH are scarce. Further, the considerable variation in estimated occurrence rates between populations, exceeds what could be expected to be caused by environmental and genetic variations. In studies on risk factors of types of PPH, emphasis has usually been placed on two main causes of PPH uterine atony or retained placenta, while important types, like PPH caused by obstetric trauma or dystocia, are widely ignored. It is important to disentangle the different types of PPH, in order to gain insight into the pathophysiological mechanisms, and to find potential clinical interventions that may reduce occurrence and severity of PPH. Main types of PPH described in literature are PPH associated with uterine atony and retention of the placenta. Postpartum hemorrhage (PPH) is the leading direct cause of maternal mortality worldwide. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: The authors have declared that no competing interests exist. The research file was financed by a research grant from The Western Norway Regional Health Authority (project no. is employed in a position at the University of Bergen: a 4-year Doctoral Research Fellowship. Code availability: The data are confidential and cannot be shared.įunding: L.E.L. Contact information: The Medical Birth Registry of Norway, University of Bergen, P.O. The main data utilized are available from the data owner, the Norwegian Institute of Public Health ( ), after obtaining approval from The Regional Committee for Medical Research Ethics ( ), for researchers who meet the criteria for access to confidential data. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: Availability of data and material: Legal restrictions do not permit the authors to provide the data that constitute the basis of this study. Received: Accepted: SeptemPublished: October 14, 2022Ĭopyright: © 2022 Linde et al. PLoS ONE 17(10):Įditor: Angela Lupattelli, University of Oslo, NORWAY (2022) Risk factors and recurrence of cause-specific postpartum hemorrhage: A population-based study. Citation: Linde LE, Rasmussen S, Moster D, Kessler J, Baghestan E, Gissler M, et al.
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