THURSDAY, Sept. 24 (HealthDay News) -- The risk of severe postpartum hemorrhage increases after induction and pre-labor cesarean section, according to a study in the September issue of the American Journal of Obstetrics & Gynecology.
Iqbal Al-Zirqi, M.D., from the University of Oslo in Norway, and colleagues analyzed data on 307,415 Norwegian mothers to determine the risk of severe postpartum hemorrhage (defined as a visually estimated blood loss of greater than 1500 mL within 24 hours after delivery or the need for a blood transfusion) based on labor onset and delivery mode.
The researchers found that 1.1 percent of all women and 2.1 percent of women with a previous cesarean delivery experienced severe postpartum hemorrhage. The risk was higher for induction (odds ratio, 1.71) and pre-labor cesarean section (odds ratio, 2.05) compared with spontaneous labor. The risk of hemorrhage was 55 percent higher for emergency cesarean section and lower for vaginal deliveries (odds ratio, 0.48) compared with pre-labor cesarean section. The risk was highest in women with a previous cesarean section who had an emergency cesarean after induction compared with spontaneous vaginal delivery in women without a previous cesarean (odds ratio, 6.57).
"Induction and pre-labor cesarean section should be practiced with caution because of the increased risk of severe postpartum hemorrhage," Al-Zirqi and colleagues conclude. "Additional prospective studies are needed to measure blood loss objectively at pre-labor cesarean section delivery, to document the exact causes of severe hemorrhage at cesarean section delivery, and to establish evidence-based guidelines for the use of induction."
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