1.
Maternal characteristics and causes associated with refractory postpartum haemorrhage after vaginal birth: a secondary analysis of the WHO CHAMPION trial data
Widmer M, Piaggio G, Hofmeyr GJ, Carroli G, Coomarasamy A, Gallos I, Goudar S, Gulmezoglu AM, Lin Lin S, Lumbiganon P, et al
BJOG : an international journal of obstetrics and gynaecology. 2019
-
-
Free full text
-
Abstract
OBJECTIVE To assess the maternal characteristics and causes associated with refractory postpartum haemorrhage (PPH). DESIGN Secondary analysis of the WHO CHAMPION trial data. SETTING 23 hospitals in 10 countries. POPULATION Women from the CHAMPION trial who received uterotonics as first line treatment of PPH. METHODS We assessed the association between socio-demographic, pregnancy and childbirth factors and refractory PPH, and compared the causes of PPH between women with refractory PPH, and women responsive to first-line PPH treatment. MAIN OUTCOME MEASURES Maternal characteristics; causes of PPH RESULTS Women with labour induced or augmented with uterotonics (aOR 1.35; 95% CI 1.07 - 1.72), with episiotomy or tears requiring suturing (aOR 1.82; 95% CI 1.34 - 2.48), and who had babies with birthweights ≥ 3500 g (aOR 1.33; 95% CI 1.04 - 1.69), showed significantly higher odds of refractory PPH compared to the reference categories in the multivariate analysis adjusted by center and trial arm. While atony was the sole PPH cause in 53.2% (116/218) of the women in the responsive PPH group, it accounted for only 31.5% (45/143) of the causes in the refractory PPH group. Conversely, tears were the sole cause in 12.8% (28/218) and 28% (40/143) of the responsive PPH and refractory PPH groups respectively. Placental problems were the sole cause in 11% and 5.6% in the responsive and refractory PPH groups respectively. CONCLUSION Women with refractory PPH showed a different pattern of maternal characteristics and PPH causes compared to those with first-line treatment responsive PPH.