TY - JOUR
T1 - Predicting Postpartum Hemorrhage After Vaginal Birth by Labor Phenotype
AU - Erickson, Elise N.
AU - Lee, Christopher S.
AU - Carlson, Nicole S.
N1 - Funding Information:
This study and its findings were presented at the 64th Annual Meeting & Exhibition of the American College of Nurse-Midwives in Washington, DC, on May 19, 2019. Study details were not recorded in paper, video, or audio format. The data included in this paper were obtained from the Consortium on Safe Labor, supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH). Institutions involved in the Consortium include the following, in alphabetical order: Baystate Medical Center, Springfield, MA; Cedars-Sinai Medical Center Burnes Allen Research Center, Los Angeles, CA; Christiana Care Health System, Newark, DE; Georgetown University Hospital, MedStar Health, Washington, DC; Indiana University Clarian Health, Indianapolis, IN; Intermountain Healthcare and the University of Utah, Salt Lake City, UT; Maimonides Medical Center, Brooklyn, NY; MetroHealth Medical Center, Cleveland, OH; Summa Health System, Akron City Hospital, Akron, OH; The EMMES Corporation, Rockville, MD (Data Coordinating Center); University of Illinois at Chicago, Chicago, IL; University of Miami, Miami, FL; and University of Texas Health Science Center at Houston, Houston, TX. The authors alone are responsible for the views expressed in this manuscript, which does not necessarily represent the decisions or the stated policy of the NICHD. The authors would like to thank the principal investigators who conducted the original Consortium on Safe Labor study as well as the NICHD for funding the study and NICHD Data and Specimen Hub for providing the data. Elise N. Erickson is supported as a scholar in the Oregon Building Interdisciplinary Research Careers in Women's Health K12 Program funded by NICHD, NIH, under award number K12HD043488. Christopher S. Lee has been supported by grants from NIH, the Office of Research on Women's Health, and the American Heart Association. Nicole S. Carlson was supported by the National Institute of Nursing Research, NIH, under award number K01NR016984 during research reported in this publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.
Funding Information:
This study and its findings were presented at the 64th Annual Meeting & Exhibition of the American College of Nurse‐Midwives in Washington, DC, on May 19, 2019. Study details were not recorded in paper, video, or audio format. The data included in this paper were obtained from the Consortium on Safe Labor, supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH). Institutions involved in the Consortium include the following, in alphabetical order: Baystate Medical Center, Springfield, MA; Cedars‐Sinai Medical Center Burnes Allen Research Center, Los Angeles, CA; Christiana Care Health System, Newark, DE; Georgetown University Hospital, MedStar Health, Washington, DC; Indiana University Clarian Health, Indianapolis, IN; Intermountain Healthcare and the University of Utah, Salt Lake City, UT; Maimonides Medical Center, Brooklyn, NY; MetroHealth Medical Center, Cleveland, OH; Summa Health System, Akron City Hospital, Akron, OH; The EMMES Corporation, Rockville, MD (Data Coordinating Center); University of Illinois at Chicago, Chicago, IL; University of Miami, Miami, FL; and University of Texas Health Science Center at Houston, Houston, TX. The authors alone are responsible for the views expressed in this manuscript, which does not necessarily represent the decisions or the stated policy of the NICHD. The authors would like to thank the principal investigators who conducted the original Consortium on Safe Labor study as well as the NICHD for funding the study and NICHD Data and Specimen Hub for providing the data. Elise N. Erickson is supported as a scholar in the Oregon Building Interdisciplinary Research Careers in Women's Health K12 Program funded by NICHD, NIH, under award number K12HD043488. Christopher S. Lee has been supported by grants from NIH, the Office of Research on Women's Health, and the American Heart Association. Nicole S. Carlson was supported by the National Institute of Nursing Research, NIH, under award number K01NR016984 during research reported in this publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.
Publisher Copyright:
© 2020 by the American College of Nurse-Midwives
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Introduction: Postpartum 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. Methods: This 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. Results: Of 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. Discussion: Women 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.
AB - Introduction: Postpartum 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. Methods: This 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. Results: Of 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. Discussion: Women 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.
KW - health disparity
KW - obesity
KW - postpartum hemorrhage
KW - third-stage labor
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U2 - 10.1111/jmwh.13104
DO - 10.1111/jmwh.13104
M3 - Article
C2 - 32286002
AN - SCOPUS:85083782287
SN - 1526-9523
VL - 65
SP - 609
EP - 620
JO - Journal of Midwifery and Women's Health
JF - Journal of Midwifery and Women's Health
IS - 5
ER -