Risk of postpartum hemorrhage according to the planned mode of delivery among pregnant women with one previous cesarean delivery: a secondary analysis of the Lower Uterine Segment Trial (LUSTrial)
Abstract
BACKGROUND
Postpartum hemorrhage is the most common complication in obstetrics and is a leading cause of serious maternal morbidity. Women with one previous cesarean delivery are at risk for postpartum hemorrhage.
OBJECTIVE
The aim of this study was to compare the risk of postpartum hemorrhage according to the planned mode of delivery among women with one previous cesarean delivery.
STUDY DESIGN
This study was a secondary analysis of the Lower Uterine Segment Trial. The primary outcome was postpartum hemorrhage, and the secondary outcome was a composite of severe postpartum hemorrhage including the need for blood transfusion, second-line therapy to stop bleeding, or hysterectomy. The exposure was the planned mode of delivery, which was decided at around 36 weeks of gestation. Multivariate logistic regression analysis with a random intercept of the maternity unit was used to assess the relationship between the planned mode of delivery and postpartum hemorrhage. A secondary analysis using inverse probability weighting was performed to limit indication bias.
RESULTS
Of the 2948 women included in the Lower Uterine Segment Trial, 2889 women were included in this secondary analysis; 2689 (93.0%) chose planned vaginal delivery and 200 (7.0%) planned cesarean delivery. The rate of postpartum hemorrhage was lower in the planned cesarean delivery group than in the planned vaginal delivery group (2.5% versus 7.5%, adjusted odds ratio 0.28 [0.11-0.69] P<.01). The rate of the composite…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 2,948 participants or records.
Read the paper
Related studies
- Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials
- Tocilizumab in patients with severe COVID-19: a retrospective cohort study
- A new aging measure captures morbidity and mortality risk across diverse subpopulations from NHANES IV: A cohort study
- Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study
- Are noise and air pollution related to the incidence of dementia? A cohort study in London, England
- Long COVID symptoms and duration in SARS-CoV-2 positive children — a nationwide cohort study
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.