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Cited by 51Maternal and fetal healthcareBlood transfusion and managementMaternal and Perinatal Health Interventions

Risk factors for obstetric morbidity in patients with uterine atony undergoing Caesarean delivery

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Butwick, A.J., Carvalho, B., El-Sayed, Y.Y.·2014·British Journal of Anaesthesia
DOI 10.1093/bja/aeu150PMC PMC4166890
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Abstract

Background Uterine atony (UA) is recognized as a leading cause of postpartum haemorrhage. However, knowledge of risk factors of haemorrhage-related morbidity among patients diagnosed with UA is uncertain. We investigated risk factors for haemorrhage-related morbidity among patients undergoing Caesarean delivery with UA.Methods We conducted a secondary analysis of data sourced from a 4-yr observational study at 19 US academic centres. Patients with UA were identified based on receiving methylergonovine or carboprost. Our primary outcome (haemorrhage-related morbidity) included a composite of intra- or postpartum transfusion; Caesarean hysterectomy; uterine or hypogastric artery ligation; intensive care admission for: pulmonary oedema, coagulopathy, adult respiratory distress syndrome, postoperative ventilation, or invasive line monitoring.Results Among 57,182 patients who underwent Caesarean delivery, 2294 (4%) patients developed UA. Haemorrhage-related morbidity occurred in 450 (19.6%) patients with UA. The risk of haemorrhage-related morbidity was increased among African-Americans [adjusted odds ratio (aOR)=2.36; 95% confidence interval (CI)=1.73-3.23], Hispanics (aOR=1.4; 95% CI=1.04-1.9), women with multiple gestations (aOR=1.59; 95% CI=1.06-2.38), placenta praevia (aOR=4.89; 95% CI=3.04-7.87), patients with ASA class III (aOR=1.4; 95 CI=1.03-1.9), or ASA class IV (aOR=5.88; 95% CI=2.48-13.9), exposure to general anaesthesia (GA) (aOR=2.4; 95% CI=1.59-3.62) and combined general and regional anaesthesia (aOR=4.0; 95% CI=2.62-6.09), and ≥2 prior Caesarean deliveries (aOR=1.62; 95% CI=1.1-2.39).Conclusions Among patients with UA undergoing Caesarean delivery, the risk of haemorrhage-related morbidity is increased in African-Americans, Hispanics, patients with multiple gestations, placenta praevia, ASA class III or IV, ≥2 prior Caesarean deliveries and those undergoing GA.

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  • A 4-year observational study at 19 US academic centres found that risk factors for haemorrhage-related morbidity are increased in those undergoing general anaesthesia.

    “A 4-year observational study at 19 US academic centres of women undergoing caesarean delivery found that the risk factors for haemorrhage-related morbidity are increased in those undergoing general anaesthesia.92”

    From Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green‐top Guideline No. 27a (2019) · cites this paper as [92]

    The Abstract reports that the data came from a four-year observational study at 19 US academic centres and that general anaesthesia was associated with increased haemorrhage-related morbidity. But the analysis was limited to women with uterine atony during Caesarean delivery; the citing sentence presents the finding as applying to women undergoing Caesarean delivery generally. (LLM, conf=0.86)

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  • Regional anaesthesia is considered safe and is associated with lower risks of haemorrhage than general anaesthesia for caesarean delivery in women with placenta praevia or a low-lying placenta.

    “Regional anaesthesia is considered safe and is associated with lower risks of haemorrhage than general anaesthesia for caesarean delivery in women with placenta praevia or a low-lying placenta.”

    From Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green‐top Guideline No. 27a (2019) · cites this paper as [92]

    The Results and Discussion associate general anaesthesia with greater haemorrhage-related morbidity than regional anaesthesia and recommend regional anaesthesia for patients at risk of uterine atony. But the study examines patients with uterine atony, not specifically women with placenta praevia or a low-lying placenta; it does not establish the claimed safety and lower haemorrhage risk for that group. The supplied passages give section labels but no page numbers. (LLM, conf=0.87)

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  1. [11]11. Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case-control study. Br Med J 2001; 322: 1089-93 14

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Authors
Butwick, A. J., Carvalho, B., & El-Sayed, Y. Y.
Affiliations
  • Stanford University (US)
  • Stanford Medicine (US)
Corresponding author
Butwick, A.J.
ORCID
Venue
British Journal of Anaesthesia
Publisher
Elsevier BV
Published
2014-10
Volume
113
Issue
4
Pages
661-668
ISSN
0007-0912 (ISSN-L)
DOI
10.1093/bja/aeu150
PMC
PMC4166890
OpenAlex
W2136587189
Cited by
51
References
43
Citations by year
2026: 3 · 2025: 4 · 2024: 2 · 2023: 4 · 2022: 10 · 2021: 1 · 2020: 6 · 2019: 4 · 2018: 3 · 2017: 4 · 2016: 4 · 2015: 5 · 2014: 1
FWCI
4.39
Type
journal article
Language
en
Open access
Licence
Locations
  • British Journal of Anaesthesia (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
School of Medicine, Stanford University
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Biochemistry › Blood transfusion and management
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Keywords
uterine atony, postpartum hemorrhage, cesarean section, obstetric morbidity, risk factors, placenta previa, multiple pregnancy, general anesthesia, African American women, Hispanic women, ASA physical status, cesarean hysterectomy, uterine artery ligation, intensive care unit admission
MeSH terms
Adolescent, Adult, Anesthesia, Obstetrical, Black or African American, Carboprost, Cesarean Section, Female, Postpartum Hemorrhage, Hispanic or Latino, Humans, Methylergonovine, Oxytocics, Placenta Previa, Pregnancy, Pregnancy Outcome, Risk Factors, Socioeconomic Factors, Uterine Inertia, Reproducibility of Results, Body Mass Index, Delivery, Obstetric, Postpartum Period, Young Adult

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