Several factors up childbirth hemorrhage risk

NEW YORK Tue Sep 30, 2008 3:32pm EDT

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NEW YORK (Reuters Health) - An increased risk of severe hemorrhage during or following childbirth is seen with older age, emergency and elective cesarean delivery, southeast Asian ethnicity, and several other factors, researchers in Norway report.

They note that, worldwide, severe hemorrhage is the main cause of maternal deaths in childbirth. The occurrence of obstetric hemorrhage varies in developed countries and is relatively high in Norway, perhaps because of differing definitions.

To investigate further, the researchers examined Norwegian data on more than 307,000 births over a period of about 5 years. Dr. Iqbal Al-Zirqi at the University of Oslo and colleagues describe their findings in the September issue of BJOG: An International Journal of Obstetrics and Gynecology.

Severe hemorrhage, defined as blood loss of more than 1.5 liters (about 3 pints) or need for blood transfusion, was identified in 3501 of the births, or 1.1 percent.

Emergency cesarean delivery carried the highest risk for severe hemorrhage, followed by blood clotting disorders, elective caesarean delivery, and multiple pregnancies.

Age was also a risk factor, with mothers over the age of 40 years being significantly more likely to have severe hemorrhage than those aged 25 to 29 years.

Mothers of southeast Asian ethnicity were 77 percent more likely than European mothers to have severe hemorrhage. However, mothers born in the Middle East had a rate that was 40 percent lower than that of Europeans.

During the period studied, the maternal death rate was 20 per 10,000 births among those with severe hemorrhage compared with 0.4 per 10,000 for those without the condition.

These findings, the researchers conclude, should lead to "a review of obstetric management procedures."

SOURCE: BJOG: An International Journal of Obstetrics and Gynecology, September 2008.