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Objective

Labor induction is an increasingly common procedure, even among women at low risk, although evidence to assess its risks remains sparse. Our objective was to assess the association between induction of labor and postpartum hemorrhage PPH in low-risk parturients, globally and according to its indications and methods.

Method

Population-based case-control study of low-risk women who gave birth in 106 French maternity units between December 2004 and November 2006, including 4450 women with PPH, 1125 of them severe, and 1744 controls. Indications for labor induction were standard or non-standard, according to national guidelines. Induction methods were oxytocin or prostaglandins. Multilevel multivariable logistic regression modelling was used to test the independent association between induction and PPH, quantified as odds ratios.

Results

After adjustment for all potential confounders, labor induction was associated with a significantly higher risk of PPH adjusted odds ratio, AOR1.22, 95%CI 1.04–1.42. This excess risk was found for induction with both oxytocin AOR 1.52, 95%CI 1.19–1.93 for all and 1.57, 95%CI 1.11–2.20 for severe PPH and prostaglandins AOR 1.21, 95%CI 0.97–1.51 for all and 1.42, 95%CI 1.04–1.94 for severe PPH. Standard indicated induction was significantly associated with PPH AOR1.28, 95%CI 1.06–1.55 while no significant association was found for non-standard indicated inductions.

Conclusion

Even in low risk women, induction of labor, regardless of the method used, is associated with a higher risk of PPH than spontaneous labor. However, there was no excess risk of PPH in women who underwent induction of labor for non-standard indications. This raises the hypothesis that the higher risk of PPH associated with labor induction may be limited to unfavorable obstetrical situations.



Autor: Imane Khireddine, Camille Le Ray, Corinne Dupont, René-Charles Rudigoz, Marie-Hélène Bouvier-Colle, Catherine Deneux-Tharaux

Fuente: http://plos.srce.hr/



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