Postpartum hemorrhage: Moving from response to prevention for Alaska Native mothers

OBJECTIVE: To identify risk factors for postpartum hemorrhage in a population of Alaska Native women. METHODS: A case control study of 384 women (128 cases, 256 controls) delivering between August 1, 2018, and July 31, 2019 was conducted at a Level III maternal referral center for Alaska Native women in Alaska. Risk factors were assessed via retrospective chart review, and bivariate and conditional regression analysis were conducted to determine odds ratios (ORs) between women with and without postpartum hemorrhage. RESULTS: Body mass index ≥40 (OR 2.6; 95% confidence interval [CI: 1.4–4.5), antepartum bleeding (OR 6.3; 95% CI 1.2–31.6), previous postpartum hemorrhage (OR 5; 95% CI 2.6–9.8), suspected macrosomia (OR 2.7; 95% CI 1.4–5.3), macrosomia with birthweight ≥4000 g (OR 3.1; 95% CI 1.8–5.3), pre-eclampsia with magnesium sulfate (OR 4.0; 95% CI 2.0–8.0), length of 3(rd) stage of labor >20 minutes (OR 2.2; 95% CI 1.1–4.4), oxytocin use >12 hours (OR 5.4; 95% CI 2.0–14.6), residence in a rural community (OR 2.2; 95% CI 1.4–3.6) and vitamin D supplementation (OR 1.7; 95% CI 1.1–2.6) were associated with greater risk of postpartum hemorrhage. CONCLUSION: Analysis of clinical and geographic risk factors for postpartum hemorrhage in Alaska Native women identified important targets for prevention.