Factors associated with blood loss during precipitate labour

Authors

  • A. Rubio Álvarez SESCAM
  • M. Molina Alarcón Universidad de Castilla-La Mancha
  • A. Hernández Martínez SESCAM

DOI:

https://doi.org/10.23938/ASSN.0030

Keywords:

Haemoglobin. Precipitate labour. Risk factors.

Abstract

Background. Precipitate labour is related to the appearance of postpartum haemorrhage due to posterior uterine atony. However, preventive measures that may be effective in reducing blood loss in this type of delivery are still unknown. Therefore, the objective of this study was to determine the risk factors associated with blood loss produced in precipitate labour.

Methods. This was an observational, analytical retrospective cohort study based on a total sample of 742 women with vaginal delivery whose duration was less than 180 minutes, during the period 2010-2014. Dead foetus antepartum gestations, twin gestations and labour induction were excluded from the analysis. The main outcome variable was intrapartum blood loss.

Results. By making use of multivariate analysis, the risk factors independently associated with higher blood loss (g/dL) during precipitate labour were nulliparity (0.38; p<0.001), higher antepartum haemoglobin levels (0.23; p<0.001), higher gestational age (0.06; p<0.001), manual removal of the placenta (0.92; p=0.004) and the use of episiotomy (0.34; p<0.001). Performing active management emerges as a protective factor against increased blood loss (-0.23; p<0.001). The average loss of haemoglobin was 1.0 g/dL (standard deviation =0.92).

Conclusion. The restriction in the practice of episiotomy and the use of active management can therefore be established as key measures that professionals can modify in order to reduce blood loss during precipitate labour and to improve these mothers’ postpartum period.

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Author Biographies

A. Rubio Álvarez , SESCAM

Matrona en el servicio de Partos del Hospital La Mancha Centro

M. Molina Alarcón , Universidad de Castilla-La Mancha

PhD. Profesora en la Universidad de Castilla-La Mancha.

A. Hernández Martínez , SESCAM

PhD. Coordinador de la unidad docente de matronas del Hospital Mancha Centro

References

SEGO. Protocolos de la Sociedad Española de Ginecología y Obstetricia. Recomendaciones sobre la Asistencia al Parto, Madrid: SEGO; 2008. Disponible en: http://www.sego.es/Content/pdf/20080117_recomendacion_al_parto.pdf (consultado el día 20 de agosto de 2016).

MAHON TR, CHAZOTTE C, COHEN WR. Short labor: characteristics and outcome. Obstet Gynecol 1994; 84: 47-51.

SHEINER E, LEVY A, MAZOR M. Precipitate labor: higher rates of maternal complications. Euro J Obstet Gynecol Reprod Biol 2004; 116: 43-47.

SUZUKI S. Clinical significance of precipitous labor. J Clin Med Res 2015; 7: 150-153.

MELAMED N, GAVISH O, EISNER M, WIZNITZER A, WASSERBERG N, YOGEV Y. Third and fourth-degree perineal tears- incidence and risk factors. J Matern Fetal Neonatal Med 2013; 26: 660-664.

BIGUZZI E, FRANCHI F, AMBROGI F, IBRAHIM B, BUCCIARELLI P, ACAIA B et al. Risk factors for postpartum hemorrhage in a cohort of 6011 Italian women. Thromb Res 2012; 129: e1-e7.

MAGANN EF, EVANS S, HUTCHINSON M, COLLINS R, HOWARD BC, MORRISON JC. Postpartum hemorrhage after vaginal birth: an analysis of risk factors. South Med J 2005; 98: 419-422.

CARROLI G, CUESTA C, ABALOS E, GULMEZOGLU AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol 2008; 22: 999-1012.

RATH WH. Postpartum hemorrhage--update on problems of definitions and diagnosis. Acta Obstet Gynecol Scand 2011; 90: 421-428.

SEGO. Protocolos de la Sociedad Española de Ginecología y Obstetricia. Hemorragia postparto precoz. Prog Obstet Ginecol 2008; 51: 497-505.

OYELESE Y, SCORZA WE, MASTROLIA R, SMULIAN JC. Postpartum hemorrhage. Obstet Gynecol Clin N Am 2007: 34: 421-441.

SAY L, CHOU D, GEMMILL A, TUNCALP O, MOLLER AB, DANIELS J et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2: 323-333.

LEDUC D, SENIKAS V, LALONDE AB, BALLERMAN C, BIRINGER A, DELANEY M et al. Active management of the third stage of labour: prevention and treatment of postpartum hemorrhage. Obs Gynaecol Can 2009; 31: 980-993.

WESTHOFF G, COTTER AM, TOLOSA JE. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. Cochrane Database Syst Rev 2013; 10: CD001808.

National Institute for Health and Clinical Excellence [Internet]. Intrapartum care for healthy women and babies. Clinical Guideline 2014. Disponible en: https://www.nice.org.uk/guidance/cg55 (Consultado el 15 de agosto de 2016).

SHELDON WR, BLUM J, VOGEL JP, SOUZA JP, GULMEZOGLU AM, WINIKOFF B. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014; 121 (Suppl 1): 5-13.

ROSSEN J, OKLAND I, NILSEN OB, EGGEBO TM. Is there an increase of postpartum hemorrhage, and is severe hemorrhage associated with more frequent use of obstetric interventions? Acta Obstet Gynecol Scand 2010; 89: 1248-1255.

AL-ZIRQI I, VANGEN S, FORSEN L, STRAY-PEDERSEN B. Prevalence and risk factors of severe obstetric haemorrhage. BJOG 2008; 115: 1265-1272.

YIP R. Significance of an abnormally low or high hemoglobin concentration during pregnancy: special consideration of iron nutrition. Am J Clin Nutr 2000; 72 (Suppl 1): 272-279S.

AGHAMOHAMMADI A, ZAFARI M, TOFIGHI M. HIGH maternal hemoglobin concentration in first trimester as risk factor for pregnancy induced hypertension. Caspian J Intern Med 2011; 2: 194-197.

VAN STRALEN G, VON SCHMIDT AUF ALTENSTADT JF, BLOEMENKAMP KWM, VAN ROOSMALEN J, HUKKELHOVEN CWPM. Increasing incidence of postpartum hemorrhage: the Dutch piece of the puzzle. Acta Obstet Gynecol Scand 2016; 95: 1104-1110.

BAIS JM, ESKES M, PEL M, BONSEL GJ, BLEKER OP. Postpartum haemorrhage in nulliparous women: incidence and risk factors in low and high risk women. A Dutch population-based cohort study on standard (> or = 500 ml) and severe (> or = 1000 ml) postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol 2004; 115: 166-172.

WEBER AM, MEYN L. Episiotomy use in the United States, 1979-1997. Obstet Gynecol 2002; 100: 1177-1182.

HERNÁNDEZ-MARTÍNEZ A, PASCUAL-PEDREÑO AI, BAÑO-GARNÉS AB, MELERO-JIMÉNEZ MR, MOLINA-ALARCÓN M. Variabilidad en la tasa de episiotomías y su relación con desgarros perineales graves y morbilidad neonatal. Enferm Clin 2014; 24: 269-275.

WU LC, MALHOTRA R, ALLEN JC, JR., LIE D, TAN TC, OSTBYE T. Risk factors and midwife-reported reasons for episiotomy in women undergoing normal vaginal delivery. Arch Gynecol Obstet 2013; 288: 1249-1256.

Euro-Peristat project with SCPE and Eurocat [Internet]. European Perinatal Health Report. The health and care of pregnant women and babies in Europe in 2010. Disponible en: http://www.europeristat.com (Consultado el 4 de septiembre de 2016).

CARROLI G, MIGNINI L. Episiotomy for vaginal birth. Cochrane Database Syst Rev 2009; (1): CD000081.

KUDISH B, SOKOL RJ, KRUGER M. Trends in major modifiable risk factors for severe perineal trauma, 1996-2006. Int J Gynaecol Obstet 2008; 102: 165-170.

RUBIO-ÁLVAREZ A, MOLINA-ALARCÓN M, HERNÁNDEZ-MARTÍNEZ A. Relationship between the degree of perineal trauma at vaginal birth and change in haemoglobin concentration. Women Birth (2017). doi.org/10.1016/j.wombi.2017.02.015

TOLEDO P, MCCARTHY RJ, HEWLETT BJ, FITZGERALD PC, WONG CA. The accuracy of blood loss estimation after simulated vaginal delivery. Anesth Analg 2007; 105: 1736-1740.

PRASERTCHAROENSUK W, SWADPANICH U, LUMBIGANON P. Accuracy of blood estimation in the third stage of labour. Int J Gynecol Obstet 2000; 71: 69-70.

PATEL A, GOUDAR SS, GELLER SE, KODKANY BS, EDLAVITCH SA, WAGH K et al. Drape estimation vs. visual assessment for estimating postpartum hemorrhage. Int J Gynecol Obstet 2006; 93: 220-224.

Published

2017-08-31

How to Cite

Rubio Álvarez, A., Molina Alarcón, M., & Hernández Martínez, A. (2017). Factors associated with blood loss during precipitate labour. Anales Del Sistema Sanitario De Navarra, 40(2), 237–245. https://doi.org/10.23938/ASSN.0030

Issue

Section

Research articles