Induction of labor and risk of postpartum hemorrhage in low risk parturients.

<h4>Objective</h4>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, globa...

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Autores principales:	Imane Khireddine, Camille Le Ray, Corinne Dupont, René-Charles Rudigoz, Marie-Hélène Bouvier-Colle, Catherine Deneux-Tharaux
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/87e25ae4cf88442db5332c845decdbbf
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spelling	oai:doaj.org-article:87e25ae4cf88442db5332c845decdbbf2021-11-18T07:59:50ZInduction of labor and risk of postpartum hemorrhage in low risk parturients.1932-620310.1371/journal.pone.0054858https://doaj.org/article/87e25ae4cf88442db5332c845decdbbf2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23382990/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objective</h4>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.<h4>Method</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.Imane KhireddineCamille Le RayCorinne DupontRené-Charles RudigozMarie-Hélène Bouvier-ColleCatherine Deneux-TharauxPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 1, p e54858 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Imane Khireddine Camille Le Ray Corinne Dupont René-Charles Rudigoz Marie-Hélène Bouvier-Colle Catherine Deneux-Tharaux Induction of labor and risk of postpartum hemorrhage in low risk parturients.
description	<h4>Objective</h4>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.<h4>Method</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.
format	article
author	Imane Khireddine Camille Le Ray Corinne Dupont René-Charles Rudigoz Marie-Hélène Bouvier-Colle Catherine Deneux-Tharaux
author_facet	Imane Khireddine Camille Le Ray Corinne Dupont René-Charles Rudigoz Marie-Hélène Bouvier-Colle Catherine Deneux-Tharaux
author_sort	Imane Khireddine
title	Induction of labor and risk of postpartum hemorrhage in low risk parturients.
title_short	Induction of labor and risk of postpartum hemorrhage in low risk parturients.
title_full	Induction of labor and risk of postpartum hemorrhage in low risk parturients.
title_fullStr	Induction of labor and risk of postpartum hemorrhage in low risk parturients.
title_full_unstemmed	Induction of labor and risk of postpartum hemorrhage in low risk parturients.
title_sort	induction of labor and risk of postpartum hemorrhage in low risk parturients.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/87e25ae4cf88442db5332c845decdbbf
work_keys_str_mv	AT imanekhireddine inductionoflaborandriskofpostpartumhemorrhageinlowriskparturients AT camilleleray inductionoflaborandriskofpostpartumhemorrhageinlowriskparturients AT corinnedupont inductionoflaborandriskofpostpartumhemorrhageinlowriskparturients AT renecharlesrudigoz inductionoflaborandriskofpostpartumhemorrhageinlowriskparturients AT mariehelenebouviercolle inductionoflaborandriskofpostpartumhemorrhageinlowriskparturients AT catherinedeneuxtharaux inductionoflaborandriskofpostpartumhemorrhageinlowriskparturients
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Induction of labor and risk of postpartum hemorrhage in low risk parturients.

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