Episiotomy is associated with increased incidence of excessive intrapartum blood loss. - GreenMedInfo Summary
[Incidence and factors related to excessive intrapartum blood loss].
Enferm Clin. 2011 Sep ;21(5):256-63. Epub 2011 Sep 23. PMID: 21944931
Atención Primaria, Área de Salud, Alcázar de San Juan, Ciudad Real, España.
INTRODUCTION: Childbirth and postpartum carry a high potential risk to the woman, with bleeding being a major cause of morbidity and mortality. A drop in haemoglobin ≥ 3.5g during the delivery process is considered as excessive bleeding, and is used as an indicator of quality of care in childbirth.
OBJECTIVE: To determine the incidence and factors associated with excessive intrapartum blood loss.
SUBJECTS AND METHODS: Hybrid design nested case-control study was performed in a cohort of 1488 pregnant women who gave birth at the Hospital La Mancha-Centro in 2008. We selected all the cases (84 subjects with a haemoglobin loss of ≥ 3.5g) and twice the number of controls (164) matched by time of delivery. Multivariate analysis was performed using conditional logistic regression.
RESULTS: The incidence of excessive intrapartum bleeding was 6.6%, with no significant differences regarding the mode of delivery (Vaginal and Caesarean=6.8%=5.6%). Antepartum anaemia was around 10% and postpartum anaemia 41.4%. We found no factors associated with bleeding in Caesarean deliveries. However, in the vaginal primiparity, manual removal and particularly the practice of episiotomy [OR=4.82 (95% CI, 1.73 to 13.44] are presented as clear risk factors.
CONCLUSION: The incidence of excessive bleeding is above recommended levels. Primiparity, manual removal and particularly episiotomy are risk factors for bleeding.