The increasing role of a retained placenta in postpartum blood loss: a cohort study
- 4 Downloads
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.
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.
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
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.
KeywordsPostpartum haemorrhage Retained placenta Third stage of labour Pregnancy blood loss
We would like to thank Steen Rasmussen and Tobias W. Klausen for their contribution to data extraction and statistical analyses.
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.
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.
This study fulfils all Danish ethical standards and was approved by the Danish Data Protection Agency (No. 2012-58-0004).
- WHO, UNICEF, UNFPA TWB and the UNPD WHO | Trends in Maternal Mortality: 1990 to 2015. World Health Organization, 2015. [https://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/]. In: Last accessed 20 July 2016
- 7.Anderson JM, Etches D (2007) Prevention and management of postpartum hemorrhage. Am Fam Physician 75:875–882Google Scholar
- The Danish Society of Obstetrics and Gynaecology Guideline for Postpartum Haemorrhage. Denmark: DSOG, 2013 [https://www.dsog.dk/files/postpartum_bloedning.pdf]. In: Last accessed 20 June 2016
- Royal College of Obstetricians and Gynaecologists Postpartum Haemorrhage, Prevention and Management (Green-top Guideline No52). London: RCOG, 2011. [https://www.rcog.org.uk/womens-health/clinical-guidance/prevention-and-management-postpartum-haemorrhage-green-top-52]. In: Last accessed 20 June 2016
- 14.Magann EF, Evans S, Chauhan SP et al (2005) The length of the third stage of labor and the risk of postpartum hemorrhage. Obstet Gynecol 105:290–293. https://doi.org/10.1097/01.AOG.0000151993.83276.70 CrossRefGoogle Scholar
- 28.Bais JM, Eskes M, Pel M et al (2004) Postpartum haemorrhage in nulliparous women: incidence and risk factors in low and high risk women: A Dutch population-based cohort study on standard (≥500 ml) and severe (≥1000 ml) postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol 115:166–172. https://doi.org/10.1016/j.ejogrb.2003.12.008 Google Scholar