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The increasing role of a retained placenta in postpartum blood loss: a cohort study

  • Hellen McKinnon EdwardsEmail author
  • Jens Anton Svare
  • Anne Juul Wikkelsø
  • Jeannet Lauenborg
  • Jens Langhoff-Roos
Maternal-Fetal Medicine
  • 4 Downloads

Abstract

Purpose

To describe the association between quantity of blood loss, duration of the third stage of labour, retained placenta and other risk factors, and to describe the role of a retained placenta depending on the cutoff used to define postpartum haemorrhage.

Methods

Cohort study of all vaginal deliveries at two Danish maternity units between 1 January 2009 and 31 December 2013 (n = 43,357), univariate and multivariate linear regression statistical analyses.

Results

A retained placenta was shown to be a strong predictor of quantity of blood loss and duration of the third stage of labour a weak predictor of quantity of blood loss. The predictive power of the third stage of labour was further reduced in the multivariate analysis when including retained placenta in the model. There was an increase in the role of a retained placenta depending on the cutoff used to define postpartum haemorrhage, increasing from 12% in cases of blood loss ≥ 500 ml to 53% in cases of blood loss ≥ 2000 ml

Conclusion

The predictive power of duration of the third stage of labour in regard to postpartum blood loss was diminished by the influence of a retained placenta. A retained placenta was, furthermore, present in the majority of most severe cases.

Keywords

Postpartum haemorrhage Retained placenta Third stage of labour Pregnancy blood loss 

Notes

Acknowledgements

We would like to thank Steen Rasmussen and Tobias W. Klausen for their contribution to data extraction and statistical analyses.

Author contributions

HME: project development, data collection, data analysis, and manuscript writing. JL-R: project development, data collection, data analysis, and manuscript editing. AJW: project development and manuscript editing. JAS: project development and manuscript editing. JL: project development and manuscript editing.

Funding

This study received funding from the Department of Obstetrics and Gynaecology, Herlev Hospital, Denmark.

Compliance with ethical standards

Conflicts of interest

HE, JL, AW, JS, and JLR declare that we have no conflicts of interest or financial ties to disclose.

Ethical approval

This study fulfils all Danish ethical standards and was approved by the Danish Data Protection Agency (No. 2012-58-0004).

Supplementary material

404_2019_5066_MOESM2_ESM.docx (23 kb)
Supplementary file1 Univariate linear regression analysis of risk factors for prediction of quantity of postpartum blood loss after vaginal delivery [proportions and percent (%) are depicted for categorical data and medians and interquartile ranges (IQR) for non-normally distributed data] (DOCX 20 kb)
404_2019_5066_MOESM1_ESM.docx (20 kb)
Supplementary file2 Multivariate linear regression analysis of all models for prediction of quantity of postpartum blood loss after vaginal delivery [proportions and percent (%) are depicted for categorical data and medians and interquartile ranges (IQR) for non-normally distributed data] (DOCX 23 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyCopenhagen University Hospital HerlevHerlevDenmark
  2. 2.Department of Anaesthesia and Intensive Care MedicineCopenhagen University Hospital HerlevHerlevDenmark
  3. 3.Department of ObstetricsJuliane Marie Centre, RigshospitaletCopenhagenDenmark

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