{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:22:38Z","timestamp":1790792558356,"version":"4.1.0"},"reference-count":12,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,1,8]],"date-time":"2020-01-08T00:00:00Z","timestamp":1578441600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the maternal characteristics and causes associated with refractory postpartum haemorrhage (PPH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Secondary analysis of the WHO CHAMPION trial data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Twenty\u2010three hospitals in ten countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>Women from the CHAMPION trial who received uterotonics as first\u2010line treatment of PPH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We assessed the association between sociodemographic, pregnancy and childbirth factors and refractory PPH, and compared the causes of PPH between women with refractory PPH and women responsive to first\u2010line PPH treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Maternal characteristics; causes of PPH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Women with labour induced or augmented with uterotonics (adjusted odds ratio [aOR] 1.35; 95% CI 1.07\u20131.72), with episiotomy or tears requiring suturing (aOR 1.82; 95% CI 1.34\u20132.48) and who had babies with birthweights \u22653500\u00a0g (aOR 1.33; 95% CI 1.04\u20131.69) showed significantly higher odds of refractory PPH compared with the reference categories in the multivariate analysis adjusted by centre and trial arm. While atony was the sole PPH cause in 53.2% (116\/218) of the women in the responsive PPH group, it accounted for only 31.5% (45\/143) of the causes in the refractory PPH group. Conversely, tears were the sole cause in 12.8% (28\/218) and 28% (40\/143) of the responsive PPH and refractory PPH groups, respectively. Placental problems were the sole cause in 11 and 5.6% in the responsive and refractory PPH groups, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Women with refractory PPH showed a different pattern of maternal characteristics and PPH causes compared with those with first\u2010line treatment responsive PPH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Tweetable abstract<\/jats:title>\n                    <jats:p>Women with refractory postpartum haemorrhage are different from those with first\u2010line treatment responsive PPH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.16040","type":"journal-article","created":{"date-parts":[[2019,12,6]],"date-time":"2019-12-06T04:24:42Z","timestamp":1575606282000},"page":"628-634","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Maternal characteristics and causes associated with refractory postpartum haemorrhage after vaginal birth: a secondary analysis of the WHO CHAMPION trial data"],"prefix":"10.1111","volume":"127","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4866-109X","authenticated-orcid":false,"given":"M","family":"Widmer","sequence":"first","affiliation":[{"name":"Department of Reproductive Health and Research World Health Organization UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Piaggio","sequence":"additional","affiliation":[{"name":"Statistika Consultoria Campinas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3080-1007","authenticated-orcid":false,"given":"GJ","family":"Hofmeyr","sequence":"additional","affiliation":[{"name":"Effective Care Research Unit Fort Hare and Walter Sisulu and Eastern Cape Department of Health Universities of Witwatersrand Witwatersrand South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Carroli","sequence":"additional","affiliation":[{"name":"Centro Rosarino de Estudios Perinatales Rosario Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Coomarasamy","sequence":"additional","affiliation":[{"name":"Institute of Metabolism and Systems Research University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I","family":"Gallos","sequence":"additional","affiliation":[{"name":"Institute of Metabolism and Systems Research University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Goudar","sequence":"additional","affiliation":[{"name":"KLE Academy of Higher Education and Research J N Medical College Belagavi Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4674-0998","authenticated-orcid":false,"given":"AM","family":"G\u00fclmezoglu","sequence":"additional","affiliation":[{"name":"Department of Reproductive Health and Research World Health Organization UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SL","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Lumbiganon","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Faculty of Medicine Khon Kaen University Khon Kaen Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Mugerwa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology School of Medicine Makerere University College of Health Sciences Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O","family":"Owa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Mother and Child Hospital Akure Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology School of Medicine University of Nairobi Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7024-8701","authenticated-orcid":false,"given":"F","family":"Althabe","sequence":"additional","affiliation":[{"name":"Department of Reproductive Health and Research World Health Organization UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,1,8]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2008.08.004"},{"key":"e_1_2_6_3_1","volume-title":"WHO Recommendations for the Prevention and Treatment of Postpartum 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