Predicting Postpartum Hemorrhage After Vaginal Birth by Labor Phenotype

• DOI: 10.1111/jmwh.13104
• Publication Date: 2020-04-14T12:25:53Z
• Authors: Elise N. Erickson; Christopher S. Lee; Nicole S. Carlson
• Keywords: Adult; obesity; Black People; third-stage labor; Cohort Studies; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Pregnancy; Risk Factors; Odds Ratio; Humans; Retrospective Studies; Labor, Obstetric; Postpartum Hemorrhage; Parturition; Hispanic or Latino; 3. Good health; Parity; Phenotype; postpartum hemorrhage; Female; health disparity; Labor Stage, Third

IntroductionPostpartum hemorrhage (PPH) is an important contributor to maternal morbidity and mortality. Predicting which laboring women are likely to have a PPH is an active area of research and a component of quality improvement bundles. The purpose of this study was to identify phenotypes of labor processes (ie, labors that have similar features, such as duration and type of interventions) in a cohort of women who had vaginal births, estimate the likelihood of PPH by phenotype, and analyze how maternal and fetal characteristics relate to PPH risk by phenotype.MethodsThis study utilized the Consortium for Safe Labor dataset (2002‐2008) and examined term, singleton, vaginal births. Using 16 variables describing the labor and birth processes, a latent class analysis was performed to describe distinct labor process phenotypes.ResultsOf 24,729 births, 1167 (4.72%) women experienced PPH. Five phenotypes best fit the data, reflecting labor interventions, duration, and complications. Women who had shorter duration of admission after spontaneous labor onset (admitted in latent or active labor) had the lowest rate of PPH (3.8%‐3.9%). The 2 phenotypes of labor progress characterized by women who had complicated prolonged labors (spontaneous or induced) had the highest rate of PPH (8.0% and 12.0%, respectively). However, the majority of PPH (n = 881, 75%) occurred in the phenotypes with fewer complications. Prepregnancy body mass index did not predict PPH. Overall, the odds of PPH were highest among nulliparous women (odds ratio [OR], 1.52; 95% CI, 1.30‐1.77), as well as Black women (OR, 1.39; 95% CI, 1.13‐1.73) and Hispanic women (OR, 1.85; 95% CI, 1.56‐2.20). Within phenotypes, maternal race and ethnicity, nulliparity, macrosomia, hypertension, and depression were associated with increased odds of PPH.DiscussionWomen who were classified into a lower‐risk labor phenotype and still experienced PPH were more likely to be nulliparous, a person of color, or diagnosed with hypertension.