PREDICTION OF HEMORRHAGE AT CESAREAN DELIVERY

Objective: To identify and quantitate the risk factors that might be p redictive of hemorrhage during abdominal delivery. Methods: Over a 2-y ear period, 1610 women underwent cesarean delivery and 127 (7.9%) had hemorrhage, defined as a decrease in hematocrit of 10% or greater, est imated blood loss greater than 1500 mt, or packed red blood cell admin istration. These women were compared through a case-control study desi gn with the next abdominal birth without hemorrhage that could be matc hed for age, parity, indication for cesarean delivery, type of anesthe sia, type of skin incision, and antepartum hematocrit. Results: Preecl ampsia (odds ratio 3.6, 95% confidence interval [CI] 1.8-7.4), disorde rs of active labor (odds ratio 4.4, 95% CI 1.4-13.7), Native American ethnicity (odds ratio 6.4, 95% CI 1.8-22.4), previous postpartum hemor rhage (odds ratio 8.4, 95% CI 1.9-37.4), and obesity of greater than 2 50 Ib (odds ratio 13.1, 95% CI 1.7-102.7) were all statistically assoc iated with significant bleeding during abdominal delivery. Combination s of two or more of these factors were associated with a markedly incr eased risk for hemorrhage, with odds ratios of 18.4 or greater. Conclu sions: Patients undergoing cesarean delivery who have factors exposing them to increased risk of hemorrhage can be identified prospectively. These women will benefit greatly from extended preoperative counselin g when possible, effective utilization of blood bank technology throug h type and cross-match requests, and preventive measures during abdomi nal delivery to minimize blood loss.