{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,7]],"date-time":"2025-06-07T11:10:04Z","timestamp":1749294604291,"version":"3.41.0"},"reference-count":22,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T00:00:00Z","timestamp":1745712000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["2019\u201001275","2023\u201006100"],"award-info":[{"award-number":["2019\u201001275","2023\u201006100"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006636","name":"Forskningsr\u00e5det om H\u00e4lsa, Arbetsliv och V\u00e4lf\u00e4rd","doi-asserted-by":"publisher","award":["2019\u201000590"],"award-info":[{"award-number":["2019\u201000590"]}],"id":[{"id":"10.13039\/501100006636","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Postpartum hemorrhage (PPH) is a key concern in maternal health, with early identification important for preventing severe complications. In a crowded delivery ward, where the number of births exceeds the normal range, labor management, and PPH prevention may be compromised. Although previous research has mainly focused on crowding over the entire day, it remains unclear whether crowding in the hours surrounding birth influences PPH risk. Therefore, our study aimed to assess the association between delivery ward crowding, adjacent to birth, and PPH and to explore whether births during periods of potentially lower staffing, such as summer months or weekends, could amplify this risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>This case\u2010control study included 1\u2009027\u2009620 births in Sweden (2004\u20132019) from the Medical Birth Register. PPH, defined as estimated blood loss &gt;1000\u2009mL, cases were identified using a diagnostic code for PPH and were matched (1:10) with controls by the standardization criteria: delivery ward, year, and time of birth (night\/day). The secondary outcome was PPH with blood transfusion. After standardization, crowding was defined as the number of births in a \u00b12\u2010h interval around the index birth exceeding the 75th percentile. Unadjusted conditional logistic regression was used to study the association between crowding and PPH, PPH with blood transfusion, and to examine whether giving birth during a weekend or summer vacation month (June\u2013August) modified these associations. Results were presented as odds ratios (OR) with 95% confidence intervals (CI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Labor induction and emergency cesarean delivery were less common in births that occurred during crowded compared to noncrowded time intervals. Crowding was not associated with an increased risk of PPH (OR: 0.97; 95% CI: 0.95\u20130.99) or PPH with blood transfusion (OR: 0.99; 95% CI: 0.92\u20131.07). Giving birth during a summer month or a weekend did not change the estimates for the association between crowding and PPH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Focusing on a narrow time frame around birth, crowding in the delivery ward was not associated with an increased, but instead a modest reduction, in risk of PPH. Future studies should investigate how staffing in relation to crowding influences the risk of PPH and other adverse birth outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.15137","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T05:19:12Z","timestamp":1745817552000},"page":"1295-1303","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The relationship between crowding in the delivery ward and the risk of postpartum hemorrhage"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9417-6936","authenticated-orcid":false,"given":"Linnea V.","family":"Ladfors","sequence":"first","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine, Solna Karolinska Institutet  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9124-3264","authenticated-orcid":false,"given":"Natalie","family":"Holowko","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine, Solna Karolinska Institutet  Stockholm Sweden"},{"name":"The Ritchie Centre, Hudson Institute of Medical Research  Clayton Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Can","family":"Liu","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine, Solna Karolinska Institutet  Stockholm Sweden"},{"name":"Centre for Health Equity Studies (CHESS) Stockholm University\/Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Public Health Sciences Stockholm University  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louise","family":"Lundborg","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine, Solna Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Women's Health Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8612-6277","authenticated-orcid":false,"given":"Mia","family":"Ahlberg","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine, Solna Karolinska Institutet  Stockholm Sweden"},{"name":"Center for Epidemiology and Community Medicine, Region Stockholm  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredrik","family":"Granath","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine, Solna Karolinska Institutet  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1528-4563","authenticated-orcid":false,"given":"Olof","family":"Stephansson","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine, Solna Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Women's Health Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,4,27]]},"reference":[{"doi-asserted-by":"publisher","key":"e_1_2_13_2_1","DOI":"10.1055\/s-0031-1280856"},{"doi-asserted-by":"publisher","key":"e_1_2_13_3_1","DOI":"10.1093\/intqhc\/mzy153"},{"volume-title":"I tid och otid. En f\u00f6rdjupningsstudie om bemanningen i f\u00f6rlossningsv\u00e5rden. Rapport 2023:5 [In good and bad times. An in\u2010depth study of staffing in maternity care]","year":"2023","author":"Swedish Agency for Health and Care Services Analysis","key":"e_1_2_13_4_1"},{"volume-title":"Kompetensf\u00f6rs\u00f6rjning av barnmorskor i f\u00f6rlossningsv\u00e5rden [Competence provision of midwives in obstetric care]","year":"2023","author":"The National Health Competence Council","key":"e_1_2_13_5_1"},{"doi-asserted-by":"publisher","key":"e_1_2_13_6_1","DOI":"10.1136\/bmjqs-2016-005257"},{"doi-asserted-by":"publisher","key":"e_1_2_13_7_1","DOI":"10.1016\/j.jhealeco.2020.102399"},{"doi-asserted-by":"publisher","key":"e_1_2_13_8_1","DOI":"10.1186\/s12884-021-03552-8"},{"doi-asserted-by":"publisher","key":"e_1_2_13_9_1","DOI":"10.1007\/s10654-022-00947-5"},{"volume-title":"Diagnoshandbok f\u00f6r kvinnosjukv\u00e5rden 2014 [Diagnostic manual for women's healthcare 2014]","year":"2014","author":"Swedish Society of Obstetrics and Gynecology","key":"e_1_2_13_10_1"},{"doi-asserted-by":"publisher","key":"e_1_2_13_11_1","DOI":"10.1515\/jci-2012-0002"},{"doi-asserted-by":"publisher","key":"e_1_2_13_12_1","DOI":"10.1097\/AOG.0b013e3182a2dd93"},{"doi-asserted-by":"publisher","key":"e_1_2_13_13_1","DOI":"10.1111\/aogs.13994"},{"doi-asserted-by":"publisher","key":"e_1_2_13_14_1","DOI":"10.1111\/1471-0528.16931"},{"doi-asserted-by":"publisher","key":"e_1_2_13_15_1","DOI":"10.1016\/j.ajog.2017.04.016"},{"key":"e_1_2_13_16_1","first-page":"1887","article-title":"Robust causal inference using directed acyclic graphs: the R package \u2018dagitty\u2019","volume":"45","author":"Textor J","year":"2017","journal-title":"Int J Epidemiol"},{"doi-asserted-by":"publisher","key":"e_1_2_13_17_1","DOI":"10.1111\/aogs.14980"},{"volume-title":"Annual Leave Act; SFS 1977:480","key":"e_1_2_13_18_1"},{"doi-asserted-by":"publisher","key":"e_1_2_13_19_1","DOI":"10.1016\/j.midw.2023.103902"},{"doi-asserted-by":"publisher","key":"e_1_2_13_20_1","DOI":"10.1016\/j.ajog.2009.06.007"},{"key":"e_1_2_13_21_1","first-page":"e106","article-title":"Prevention and management of postpartum haemorrhage: green\u2010top guideline No. 52","volume":"124","author":"Green\u2010top Guideline No","year":"2017","journal-title":"BJOG"},{"unstructured":"WHO Guidelines Approved by the Guidelines Review Committee.WHO recommendations: uterotonics for the prevention of postpartum haemorrhage. 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