Risk factors for postpartum hemorrhage according to the Robson classification in a low-risk maternity hospital

Botelho, Amanda; Invitti;, Adriana Luckow; Mattar, Rosiane; Pares, David Baptista da Silva; Salmeron, Camilla Parente; Caldas, João Victor Jacomele; Mello, Nathalia; Peixoto, Alberto Borges; Araujo Júnior, Edward; Sun, Sue Yazaki

doi:10.61622/rbgo/2024rbgo53

Amanda Botelho

were involved in the design and interpretation of the analysis

contributed to the writing of the manuscript and read and approved the final manuscript

Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

https://orcid.org/0000-0002-2121-023X

Adriana Luckow Invitti;

were involved in the design and interpretation of the analysis

contributed to the writing of the manuscript and read and approved the final manuscript

Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Beneficent Association of Blood Collection, São Paulo, SP, Brazil.

https://orcid.org/0000-0003-2392-2887

Rosiane Mattar

were involved in the design and interpretation of the analysis

contributed to the writing of the manuscript and read and approved the final manuscript

Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Hospital Amparo Maternal, São Paulo, SP, Brazil.

https://orcid.org/0000-0003-1405-5371

David Baptista da Silva Pares

were involved in the design and interpretation of the analysis

contributed to the writing of the manuscript and read and approved the final manuscript

Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Hospital Amparo Maternal, São Paulo, SP, Brazil.

https://orcid.org/0000-0003-0800-0761

Camilla Parente Salmeron

were involved in the design and interpretation of the analysis

contributed to the writing of the manuscript and read and approved the final manuscript

Hospital Amparo Maternal, São Paulo, SP, Brazil.

https://orcid.org/0009-0002-4052-301X

João Victor Jacomele Caldas

were involved in the design and interpretation of the analysis

contributed to the writing of the manuscript and read and approved the final manuscript

Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

https://orcid.org/0000-0003-2333-6159

Nathalia Mello

were involved in the design and interpretation of the analysis

contributed to the writing of the manuscript and read and approved the final manuscript

Hospital Amparo Maternal, São Paulo, SP, Brazil.

https://orcid.org/0000-0002-9008-8178

Alberto Borges Peixoto

were involved in the design and interpretation of the analysis

contributed to the writing of the manuscript and read and approved the final manuscript

Gynecology and Obstetrics Service, Hospital Universitário Mário Palmério, Universidade de Uberaba, Uberaba, MG, Brazil.

Department of Obstetrics and Gynecology, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil.

https://orcid.org/0000-0002-1655-3609

Edward Araujo Júnior

were involved in the design and interpretation of the analysis

contributed to the writing of the manuscript and read and approved the final manuscript

Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

https://orcid.org/0000-0002-6145-2532

Sue Yazaki Sun

were involved in the design and interpretation of the analysis

contributed to the writing of the manuscript and read and approved the final manuscript

Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Hospital Amparo Maternal, São Paulo, SP, Brazil.

https://orcid.org/0000-0001-6573-7386

Corresponding author: Edward Araujo Júnior E-mail: araujojred@terra.com.br

Conflicts to interest: none to declare.

Associate Editor : Gabriel Costa Osanan (https://orcid.org/0000-0001-9130-8745) Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil

Variables	Group I (5,750)	Group II (3,124)	p-value
Age (years)	25.6 (6.2)	26.0 (5.9)	0.010 ^†
Number of pregnancies	2.0 (0.0-10.0)	1.0 (1.0-9.0)	0.043 ^∫
Previous delivery			<0.001 ^§
Nulliparous	53,1% (3,053/5,750)	66,1% (2,085/3,124)
Multiparous	46.9% (2,697-5,750)	33,3% (1,039-3,124)
Gestational age (weeks)	39.4 (37.4-43.6)	40.4 (37.4-42.6)	<0.001 ^∫
Hemorrhagic risk assessment admission
High	2.5% (2/79)	1.4% (1/73)	>0.999 ^§
Medium	5.1% (4/79)	11.0% (8/73)	0.233 ^§
Low	92.4% (73/79)	87.7% (64/73)	0.417 ^§
Use of misoprostol for labor induction	0.0% (0-5,750)	73.9% (2,310-3,124)	<0.001 ^§
Use of oxytocin for labor induction and/or conduction	9.8% (5,63/5,750)	28.0% (8,76/3,124)	<0.001 ^§
Type of delivery
Vaginal	91.7% (5,272/5,750)	62.7% (1,958/3,124)	<0.0001 ^§
Forceps	0.4% (25/5,750)	0.8% (26/3,124)	0.026 ^§
Cesarean section	7.9% (4,53/5,750)	36.5% (1,140/3,124)	<0.0001 ^§
Draw controlled cord	92.6% (5,326/5,750)	68.1% (2,128/3,124)	<0.001 ^§
Prophylactic oxytocin	99.9% (5,743/5,750)	100.0% (3,124/3,124)	0.974 ^§
Birth weight (grams)	3,255.0 (1,035.0-4,850.0)	3,330.0 (1,915.0-5,470.0)	<0.001 ^∫
Macrosomia	3.6% (204/5,711)	5.8% (181/3,097	<0.001 ^§
APGAR score at the 1st min	9.0 (0.0-10.0)	9.0 (0.0-10.0)	0.921 ^∫
APGAR score at the 5th min	9.0 (0.0-10.0)	9.0 (0.0-10.0)	0.897 ^∫

Variables	Group I (5,750)	Group II (3,124)	p-value
Postpartum hemorrhage	2.7% (153/5,750)	3.5% (109/3,124)	0.028 ^§
Shock index ≥ 0.9	1.0% (56/5,747)	1.0% (32/3,119)	0.815 ^§
Causes of postpartum hemorrhage
Uterine atony	1.4% (83/5,750)	1.9% (60/3,124)	0.088 ^§
Laceration path	0.3% (15/5,750)	0.4% (13/3,124)	0.213 ^§
Other	1.0% (58/5,750)	1.1% (33/3,124)	0.826 ^§
Volume of blood loss (ml)	200.0 (5-1,830)	250 (5-2,585)	< 0.001 ^∫
PPH treatment
Oxytocin	1.5% (85/5,749)	2.5% (79/3,124	< 0.001 ^§
Ergotamine	1.7% (95/5,750)	2.3% (71/3,124	0.039 ^§
Misoprostol	0.9% (49/5,749)	1.3% (40/3,124)	0.053 ^§
Tranexamic acid	1.6% (94/5,750)	2.1% (67/3,124)	0.086 ^§
B-Lynch hemostatic suture	0.0% (1/5,743)	0.0% (1/3,119)	0.661 ^§
Bakri balloon	0.0% (0/5,743)	0.1% (2/3,119)	0.055 ^§
Hysterectomy	0.0% (0/5,743)	0.0% (1/3,119)

	PPH	Absence PPH	OR (95%CI)	p-value
Induction of labor	41.6% (109/262)	35.0% (3,015/8,612)	1.32 (1.03-1.66)	0.030 ^§
Birth weight	3,345 (2,295-4,645)	3275 (1,035-5,470)		<0.0001 ^∫
Birth weight ≥ 4000 grams	14.4% (31/215)	4.1% (353/8,589)	3.91 (2.64-5.84)	<0.0001 ^§
Type of delivery
Vaginal	77.9% (204/262)	81.6% (7,026/8,612)	0.79 (0.60-1.06)	0.125 ^§
Forceps	3.4% (9/262)	0.5% (42/8,612)	7.25 (3.54-15.08)	<0.0001 ^§
Cesarean section	18.7% (49/262)	17.9% (1,544/8,612)	1.05 (0.76-1.45)	0.743 ^§

Variables	aOR	95% CI	p-value
Robinson Classification 2A and 4A	1.24	0.971-1.607	0.083
Type of delivery			<0.001
Cesarean section	1.003	0.635-1.345	0.873
Forceps delivery	7.19	3,444-15,030	<0.001
Birth weight	3.07	2,078-4,554	<0.001

[1] Corresponding author: Edward Araujo Júnior E-mail: araujojred@terra.com.br

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Risk factors for postpartum hemorrhage according to the Robson classification in a low-risk maternity hospital

Abstract

Objective

Methods

Results

Conclusion