Al-Zirqi et al identified risk factors for severe obstetrical hemorrhage in Norway. These can help to identify women who may require more aggressive management. The authors are from the University of Oslo, the Norwegian Institute of Public Health and the National Resource Centre for Women's Health in Norway.


Criteria for severe obstetric hemorrhage - one or both of the following:

(1) estimated blood loss > 1,500 mL from onset of delivery to 24 hours postpartum

(2) postpartum blood transfusion for obstetrical hemorrhage


Women with severe obstetrical hemorrhage were at greater risk for:

(1) ICU admission

(2) hysterectomy

(3) postpartum sepsis

(4) acute renal failure

(5) death


Risk factors for severe hemorrhage (adjusted odds ratio > 1.4 on multivariate analysis):

(1) South-East Asian ethnicity

(2) age >= 40 years of age

(3) multiple pregnancies

(4) von Willebrand's disease or other coagulopathy

(5) hemoglobin < 9 g/dL during pregnancy

(6) Caesarean section (emergency greater than elective)

(7) uterine atony without retained secundines

(8) retained secundines

(9) trauma

(10) abruption

(11) placenta praevia

(12) birth weight >= 4.5 kg

(13) delivery using forceps or vacuum

(14) induced labor

(15) history of previous Caesarean delivery

(16) maternal heart disease

(17) HELLP syndrome


Factors associated with reduced risk:

(1) Middle-Eastern ancestry


In the implementation a total score is used based on the number of risk factors present, with some weighted.


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