Abstract
PurposeTo explore the relationship of ethnicity and postpartum hemorrhage (PPH) for women who underwent cesarean delivery (CD) and examine the risk factors for PPH in distinct ethnic groups in China.MethodsWe conducted case–control studies with the maternity data from the 11,778 CD cases, in Xinjiang Uygur Autonomous Region. Initially, multivariable logistic regression was used to estimate the disparity of race-ethnicity on the risk of PPH in ethnic Han, Uygur, Hui and Kazakh. Then, we performed case–control studies within two major ethnic groups, identifying the specific risk factors for PPH.ResultsEthnic Uygur were associated with a statistically significant increased odds [adjusted odds ratios (aOR) 2.05; 95% confidence interval (CI) 1.26–3.33] of PPH compared with ethnic Han. For subgroup analyses, in Uygur subgroup, general anesthesia (aOR 7.78; 95% CI 2.31–26.20); placenta previa (aOR 11.18; 95% CI 3.09–40.45); prenatal anemia (aOR 4.84; 95% CI 2.44–9.60); emergency surgery (aOR 4.22; 95% CI 1.95–9.13) were independently associated with PPH. In Han subgroup, general anesthesia (aOR 5.70; 95% CI 1.89–17.26); placenta previa (aOR 20.08; 95% CI 6.35–63.46); multiple pregnancy (aOR 7.21; 95% CI 1.61–32.37); body mass index (aOR 1.19; 95% CI 1.07–1.31) were the risk factors to PPH.ConclusionUygur have more tendency to PPH compared to Han, and risk factors for PPH in Uygur and Han groups may differ. Knowing these differences may be meaningful when planning interventions and resources for high-risk patients undergoing cesarean delivery, and we need more research aimed at risk factors for PPH.
Highlights
MethodsPostpartum hemorrhage (PPH) is a severe complication that may result in adverse outcomes of perinatal mothers and infants
postpartum hemorrhage (PPH) Postpartum hemorrhage cesarean delivery (CD) Cesarean delivery ICD-9-CM codes International Classification of Diseases 9th revision codes, Clinical Modification codes ASA American Society of Anesthesiologists estimated blood loss (EBL) Estimated blood loss red blood cell (RBC) Red blood cell body mass index (BMI) Body mass index cesarean delivery on maternal request (CDMR) Cesarean delivery on maternal request odds ratios (ORs) Odds ratios 95% confidence interval (CI) 95% Confidence intervals adjusted odds ratios (aOR) Adjusted odds ratio variance inflation factor (VIF) Variance inflation factor
For ethnic Uygur subgroup, placenta previa, general anesthesia, prenatal anemia and emergency surgery were independently associated with PPH
Summary
MethodsPostpartum hemorrhage (PPH) is a severe complication that may result in adverse outcomes of perinatal mothers and infants. PPH is the major cause of maternal mortality in China which accounted for 28% of all maternal deaths in 2013 [2]. It is an important cause of pregnancy-related morbidity, such as multi-organ failure and peripartum hysterectomy [1, 3]. There are a variety of etiologies of PPH, including uterine atony, retained placenta, lacerations of the birth canal, uterine rupture, placenta accreta, various types of coagulopathies, uterine inversion and infection, each of which has diverse risk factors [4, 5]. The major cause of PPH is uterine atony, accounting for approximately 80% of PPH cases, and often occurs in the absence of recognized risk factors [6]. It is necessary to determine risk factors for PPH to plan interventions and resources for high-risk patients
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