{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T22:08:16Z","timestamp":1773180496533,"version":"3.50.1"},"reference-count":46,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,3,10]],"date-time":"2021-03-10T00:00:00Z","timestamp":1615334400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>To identify risk factors for severe postpartum hemorrhage (PPH) \u22651000\u00a0ml in women giving birth vaginally.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A register\u2010based cohort study including women with singleton pregnancies giving birth vaginally at term to a live\u2010born child at Aarhus University Hospital, Denmark, from January 1, 2004, to December 31, 2012. Logistic multivariable regression was used to analyze data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 31\u00a0837 births, 1832 women (5.7%) experienced severe PPH. Maternal age, smoking during pregnancy, and prepregnancy body mass index did not increase the risk of severe PPH. However, nulliparous and multiparous women with a previous cesarean birth had an increased risk of severe PPH. Antepartum and intrapartum risk factors for severe PPH included gestational age &gt;40\u00a0weeks, induction of labor, augmentation of labor, irregular fetal position, instrumental birth, and birthweight &gt;4000\u00a0g. In particular, the combination of induction and augmentation of labor doubled the risk of severe PPH. Among genital tract tears, vaginal tears &gt;3\u00a0cm were associated with the highest risk of severe PPH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Maternal characteristics did not increase the risk of severe PPH, except for nulliparous and multiparous women with a previous cesarean birth. Obstetric interventions such as induction of labor, augmentation of labor, and a birthweight higher than 4000\u00a0g increased the risk of severe PPH. Larger vaginal tears presented the highest risk of severe PPH. Clinical practice with rigorous indications for obstetric interventions and timely identification and management of genital tract tears may reduce risk of severe PPH.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12543","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T06:00:31Z","timestamp":1615442431000},"page":"338-346","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Is the increase in postpartum hemorrhage after vaginal birth because of altered clinical practice?: A register\u2010based cohort study"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5796-1270","authenticated-orcid":false,"given":"Hanne L\u00f8nstrup","family":"Graugaard","sequence":"first","affiliation":[{"name":"Department of Midwifery University College South Denmark Esbjerg Denmark"},{"name":"Department of Obstetrics and Gynecology Aarhus University Hospital Aarhus Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1776-5475","authenticated-orcid":false,"given":"Rikke Damkj\u00e6r","family":"Maimburg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Aarhus University Hospital Aarhus Denmark"},{"name":"Department of Clinical Medicine Aarhus University Aarhus Denmark"},{"name":"School of Nursing and Midwifery Western Sydney University Greater Western Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,3,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68397-9"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12636"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-012-2301-y"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-9-55"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/17474086.2016.1245135"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2011.03198.x"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.07.007"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-015-3725-y"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12950"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-015-0788-5"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31822a6c59"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-016-1217-0"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016349.2010.514324"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13098"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14178"},{"issue":"3","key":"e_1_2_9_18_1","first-page":"B5444","article-title":"Aetiology and treatment of severe postpartum haemorrhage","volume":"65","author":"Edwards HM","year":"2018","journal-title":"Danish Med J"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-011-1279-z"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-019-2633-8"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/1746-4358-5-5"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01859.x"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12588"},{"key":"e_1_2_9_24_1","volume-title":"WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage","author":"World Health Organization","year":"2012"},{"key":"e_1_2_9_25_1","volume-title":"WHO Guidelines for the Management of Postpartum Haemorrhage and Retained Placenta","author":"World Health Organization","year":"2009"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2008.08.004"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14417"},{"key":"e_1_2_9_28_1","volume-title":"WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience","author":"World Health Organization","year":"2018"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31472-6"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32585-5"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0175306"},{"key":"e_1_2_9_32_1","unstructured":"The National Committee on Health Research E.Act on research ethics review of health research projects. 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