Postpartum hemorrhage: Moving from response to prevention for Alaska Native mothers

• Published in: International journal of gynecology and obstetrics Vol. 155; no. 2; pp. 290 - 295
• Main Authors: Hadley, Megan E., Day, Gretchen, Beans, Julie A., Groen, Reinou S.
• Format: Journal Article
• Language: English
• Published: United States 01.11.2021
• Subjects: Alaska; Alaska Natives; Case-Control Studies; Female; Humans; indigenous peoples; maternal health; Mothers; postpartum hemorrhage; Postpartum Hemorrhage - epidemiology; Postpartum Hemorrhage - prevention & control; Pregnancy; pregnancy complications; Retrospective Studies; risk factors; postpartum hemorrhage; risk factors; pregnancy; Alaska; maternal health; pregnancy complications; indigenous peoples
• ISSN: 0020-7292; 1879-3479; 1879-3479
• DOI: 10.1002/ijgo.13883

Objective To identify risk factors for postpartum hemorrhage in a population of Alaska Native women. Methods A case‐control study of 384 women (128 cases, 256 controls) delivering between August 1, 2018, and July 31, 2019, was conducted at a Level III maternal referral center for Alaska Native women in Alaska. Risk factors were assessed via retrospective chart review, and bivariate and conditional regression analyses were conducted to determine odds ratios (ORs) between women with and without postpartum hemorrhage. Results Body mass index ≥40 (OR 2.6, 95% confidence interval [CI] 1.4–4.5), antepartum bleeding (OR 6.3, 95% CI 1.2–31.6), previous postpartum hemorrhage (OR 5, 95% CI 2.6–9.8), suspected macrosomia (OR 2.7, 95% CI 1.4–5.3), macrosomia with birthweight ≥4000 g (OR 3.1, 95% CI 1.8–5.3), pre‐eclampsia with magnesium sulfate (OR 4.0, 95% CI 2.0–8.0), length of third stage of labor >20 min (OR 2.2, 95% CI 1.1–4.4), oxytocin use >12 h (OR 5.4, 95% CI 2.0–14.6), residence in a rural community (OR 2.2, 95% CI 1.4–3.6), and vitamin D supplementation (OR 1.7, 95% CI 1.1–2.6) were associated with greater risk of postpartum hemorrhage. Conclusion Analysis of clinical and geographic risk factors for postpartum hemorrhage in Alaska Native women identified important targets for prevention. Synopsis The study elicited factors contributing to the higher risk of postpartum hemorrhage in a population of Alaska Native women that are important targets for prevention.