{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:09:45Z","timestamp":1787022585957,"version":"build-2736575974"},"reference-count":33,"publisher":"Walter de Gruyter GmbH","issue":"7","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jpm-2024-0567_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Epidural analgesia is widely used for pain management during labor and delivery with inconsistent results regarding its influence on postpartum blood loss. Aim of our study was to investigate blood loss after vaginal delivery in women with epidural analgesia in consideration of established risk factors for postpartum hemorrhage (PPH) and by using a validated blood measurement technique.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2024-0567_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective study was performed at the University Hospital Zurich. Included were 699 women with vaginal deliveries after 34\u00a0weeks of pregnancy. Blood loss was assessed by a validated measurement technique. Risk factors for increased blood loss were assessed and stratified by epidural analgesia use. Significant variables were entered into a stepwise multivariate regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2024-0567_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the univariate analysis, women with epidural analgesia showed a significantly higher blood loss, compared to women without epidural analgesia. However, after multivariate regression analysis no association between increased blood loss and epidural anesthesia was observed. Furthermore, women with epidural analgesia were more often primiparous, experienced more often uterine atony and PPH, bleeding from perineal laceration, vacuum extraction, longer second stage of labor and bigger neonatal head circumference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2024-0567_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Epidural analgesia itself is not associated with increased postpartum blood loss. However, there is a higher incidence of PPH in deliveries with obstetric risk factors, in which more frequent use of epidural analgesia is observed. In other words, not epidural analgesia is the cause of PPH, but difficult obstetric settings are associated with both higher use of epidural analgesia and increased blood\u00a0loss.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jpm-2024-0567","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T03:16:20Z","timestamp":1747883780000},"page":"871-876","source":"Crossref","is-referenced-by-count":4,"title":["Epidural anesthesia during labor and delivery and postpartum hemorrhage"],"prefix":"10.1515","volume":"53","author":[{"given":"Maike Katja","family":"Sachs","sequence":"first","affiliation":[{"name":"Division of Obstetrics , University Hospital Zurich Z\u00fcrich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Kapfhammer","sequence":"additional","affiliation":[{"name":"Division of Obstetrics , University Hospital Zurich Z\u00fcrich , Switzerland"},{"name":"Division of Gynaecology and Obstetrics , 30934 Kantonsspital Winterthur Winterthur , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romana","family":"Brun","sequence":"additional","affiliation":[{"name":"Division of Gynaecology and Obstetrics , 30934 Kantonsspital Winterthur Winterthur , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Kandler","sequence":"additional","affiliation":[{"name":"Division of Obstetrics , University Hospital Zurich Z\u00fcrich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Ochsenbein","sequence":"additional","affiliation":[{"name":"Division of Obstetrics , University Hospital Zurich Z\u00fcrich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Christian Haslinger","sequence":"additional","affiliation":[{"name":"Division of Obstetrics , University Hospital Zurich Z\u00fcrich , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2025,5,23]]},"reference":[{"key":"2026051215142314128_j_jpm-2024-0567_ref_001","doi-asserted-by":"crossref","unstructured":"Butwick, AJ, Bentley, J, Wong, CA, Snowden, JM, Sun, E, Guo, N. United\u00a0States state-level variation in the use of neuraxial analgesia during labor for pregnant women. JAMA Netw Open 2018;1:e186567. https:\/\/doi.org\/10.1001\/jamanetworkopen.2018.6567.","DOI":"10.1001\/jamanetworkopen.2018.6567"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_002","doi-asserted-by":"crossref","unstructured":"Jimenez-Puente, A, Benitez-Parejo, N, Del Diego-Salas, J, Rivas-Ruiz, F, Maanon-Di, LC. Ethnic differences in the use of intrapartum epidural analgesia. BMC Health Serv Res 2012;12:207. https:\/\/doi.org\/10.1186\/1472-6963-12-207.","DOI":"10.1186\/1472-6963-12-207"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_003","doi-asserted-by":"crossref","unstructured":"Fieni, S, di Pasquo, E, Formisano, D, Basevi, V, Perrone, E, Ghi, T. Epidural analgesia and the r isk of operative delivery among women at term: a propensity score matched study. Eur J Obstet Gynecol Reprod Biol 2022;276:174\u20138. https:\/\/doi.org\/10.1016\/j.ejogrb.2022.07.028.","DOI":"10.1016\/j.ejogrb.2022.07.028"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_004","doi-asserted-by":"crossref","unstructured":"Jouppila, R, Hollmen, A. The effect of segmental epidural analgesia on maternal and foetal acid-base balance, lactate, serum potassium and creatine phosphokinase during labour. Acta Anaesthesiol Scand 1976;20:259\u201368. https:\/\/doi.org\/10.1111\/j.1399-6576.1976.tb05038.x.","DOI":"10.1111\/j.1399-6576.1976.tb05038.x"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_005","doi-asserted-by":"crossref","unstructured":"Capogna, G, Camorcia, M, Stirparo, S, Farcomeni, A. Programmed intermittent epidural bolus versus continuous epidural infusion for labor analgesia: the effects on maternal motor function and labor outcome. A randomized double-blind study in nulliparous women. Anesth Analg 2011;113:826\u201331. https:\/\/doi.org\/10.1213\/ane.0b013e31822827b8.","DOI":"10.1213\/ANE.0b013e31822827b8"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_006","doi-asserted-by":"crossref","unstructured":"Cambic, CR, Wong, CA. Labour analgesia and obstetric outcomes. Br J Anaesth 2010;105:i50\u201360. https:\/\/doi.org\/10.1093\/bja\/aeq311.","DOI":"10.1093\/bja\/aeq311"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_007","doi-asserted-by":"crossref","unstructured":"Eriksen, LM, Nohr, EA, Kjaergaard, H. Mode of delivery after epidural analgesia in a cohort of low-risk nulliparas. Birth 2011;38:317\u201326. https:\/\/doi.org\/10.1111\/j.1523-536x.2011.00486.x.","DOI":"10.1111\/j.1523-536X.2011.00486.x"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_008","unstructured":"Combs, CA, Murphy, EL, Laros, RKJr. Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol 1991;77:69\u201376."},{"key":"2026051215142314128_j_jpm-2024-0567_ref_009","doi-asserted-by":"crossref","unstructured":"Rossen, J, Okland, I, Nilsen, OB, Eggebo, TM. Is there an increase of postpartum hemorrhage, and is severe hemorrhage associated with more frequent use of obstetric interventions? Acta Obstet Gynecol Scand 2010;89:1248\u201355. https:\/\/doi.org\/10.3109\/00016349.2010.514324.","DOI":"10.3109\/00016349.2010.514324"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_010","doi-asserted-by":"crossref","unstructured":"Driessen, M, Bouvier-Colle, MH, Dupont, C, Khoshnood, B, Rudigoz, RC, Deneux-Tharaux, C. Postpartum hemorrhage resulting from uterine atony after vaginal delivery: factors associated with severity. Obstet Gynecol 2011;117:21\u201331. https:\/\/doi.org\/10.1097\/aog.0b013e318202c845.","DOI":"10.1097\/AOG.0b013e318202c845"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_011","doi-asserted-by":"crossref","unstructured":"Kramer, MS, Berg, C, Abenhaim, H, Dahhou, M, Rouleau, J, Mehrabadi, A, et al.. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol 2013;209:449.e1\u20137. https:\/\/doi.org\/10.1016\/j.ajog.2013.07.007.","DOI":"10.1016\/j.ajog.2013.07.007"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_012","doi-asserted-by":"crossref","unstructured":"MacDorman, MF, Declercq, E, Cabral, H, Morton, C. Recent increases in the U.S. Maternal mortality rate: disentangling trends from measurement issues. Obstet Gynecol 2016;128:447\u201355. https:\/\/doi.org\/10.1097\/aog.0000000000001556.","DOI":"10.1097\/AOG.0000000000001556"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_013","doi-asserted-by":"crossref","unstructured":"Guglielminotti, J, Landau, R, Daw, J, Friedman, AM, Chihuri, S, Li, G. Use of labor neuraxial analgesia for vaginal delivery and severe maternal morbidity. JAMA Netw Open 2022;5:e220137. https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.0137.","DOI":"10.1001\/jamanetworkopen.2022.0137"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_014","doi-asserted-by":"crossref","unstructured":"Haslinger, C, Korte, W, Hothorn, T, Brun, R, Greenberg, C, Zimmermann, R. The impact of prepartum factor XIII activity on postpartum blood loss. J\u00a0Thromb Haemost 2020;18:1310\u20139. https:\/\/doi.org\/10.1111\/jth.14795.","DOI":"10.1111\/jth.14795"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_015","doi-asserted-by":"crossref","unstructured":"Kahr, MK, Brun, R, Zimmermann, R, Franke, D, Haslinger, C. Validation of a quantitative system for real-time measurement of postpartum blood loss. Arch Gynecol Obstet 2018;298:1071\u20137. https:\/\/doi.org\/10.1007\/s00404-018-4896-0.","DOI":"10.1007\/s00404-018-4896-0"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_016","doi-asserted-by":"crossref","unstructured":"Ploeckinger, B, Ulm, MR, Chalubinski, K, Gruber, W. Epidural anaesthesia in labour: influence on surgical delivery rates, intrapartum fever and blood loss. Gynecol Obstet Invest 1995;39:24\u20137. https:\/\/doi.org\/10.1159\/000292370.","DOI":"10.1159\/000292370"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_017","doi-asserted-by":"crossref","unstructured":"Saunders, NS, Paterson, CM, Wadsworth, J. Neonatal and maternal morbidity in relation to the length of the second stage of labour. Br J Obstet Gynaecol 1992;99:381\u20135. https:\/\/doi.org\/10.1111\/j.1471-0528.1992.tb13753.x.","DOI":"10.1111\/j.1471-0528.1992.tb13753.x"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_018","doi-asserted-by":"crossref","unstructured":"Srebnik, N, Barkan, O, Rottenstreich, M, Ioscovich, A, Farkash, R, Rotshenker-Olshinka, K, et al.. The impact of epidural analgesia on the mode of delivery in nulliparous women that attain the second stage of labor. J\u00a0Matern Fetal Neonatal Med 2020;33:2451\u20138. https:\/\/doi.org\/10.1080\/14767058.2018.1554045.","DOI":"10.1080\/14767058.2018.1554045"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_019","doi-asserted-by":"crossref","unstructured":"Magann, EF, Evans, S, Hutchinson, M, Collins, R, Howard, BC, Morrison, JC. Postpartum hemorrhage after vaginal birth: an analysis of risk factors. South Med J 2005;98:419\u201322. https:\/\/doi.org\/10.1097\/01.smj.0000152760.34443.86.","DOI":"10.1097\/01.SMJ.0000152760.34443.86"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_020","doi-asserted-by":"crossref","unstructured":"Nyflot, LT, Sandven, I, Stray-Pedersen, B, Pettersen, S, Al-Zirqi, I, Rosenberg, M, et al.. Risk factors for severe postpartum hemorrhage: a case-control study. BMC Pregnancy Childbirth 2017;17:17. https:\/\/doi.org\/10.1186\/s12884-016-1217-0.","DOI":"10.1186\/s12884-016-1217-0"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_021","doi-asserted-by":"crossref","unstructured":"Rouse, DJ, Weiner, SJ, Bloom, SL, Varner, MW, Spong, CY, Ramin, SM, et al.. Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes. Am J Obstet Gynecol 2009;201:357. e1\u20137. https:\/\/doi.org\/10.1016\/j.ajog.2009.08.003.","DOI":"10.1016\/j.ajog.2009.08.003"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_022","doi-asserted-by":"crossref","unstructured":"Anim-Somuah, M, Smyth, RM, Jones, L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev 2011:CD000331. https:\/\/doi.org\/10.1002\/14651858.CD000331.pub3.","DOI":"10.1002\/14651858.CD000331.pub3"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_023","doi-asserted-by":"crossref","unstructured":"Cheng, YW, Shaffer, BL, Nicholson, JM, Caughey, AB. Second stage of labor and epidural use: a larger effect than previously suggested. Obstet Gynecol 2014;123:527\u201335. https:\/\/doi.org\/10.1097\/aog.0000000000000134.","DOI":"10.1097\/AOG.0000000000000134"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_024","doi-asserted-by":"crossref","unstructured":"Shen, X, Li, Y, Xu, S, Wang, N, Fan, S, Qin, X, et al.. Epidural analgesia during the second stage of labor: a randomized controlled trial. Obstet Gynecol 2017;130:1097\u2013103. https:\/\/doi.org\/10.1097\/aog.0000000000002306.","DOI":"10.1097\/AOG.0000000000002306"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_025","doi-asserted-by":"crossref","unstructured":"Lim, G, Facco, FL, Nathan, N, Waters, JH, Wong, CA, Eltzschig, HK. A review of the impact of obstetric anesthesia on maternal and neonatal outcomes. Anesthesiology 2018;129:192\u2013215. https:\/\/doi.org\/10.1097\/aln.0000000000002182.","DOI":"10.1097\/ALN.0000000000002182"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_026","doi-asserted-by":"crossref","unstructured":"Fukami, T, Koga, H, Goto, M, Ando, M, Matsuoka, S, Tohyama, A, et al.. Incidence and risk factors for postpartum hemorrhage among transvaginal deliveries at a tertiary perinatal medical facility in Japan. PLoS One 2019;14:e0208873. https:\/\/doi.org\/10.1371\/journal.pone.0208873.","DOI":"10.1371\/journal.pone.0208873"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_027","doi-asserted-by":"crossref","unstructured":"de Jonge, A, van Diem, MT, Scheepers, PL, van der Pal-de Bruin, KM, Lagro-Janssen, AL. Increased blood loss in upright birthing positions originates from perineal damage. BJOG 2007;114:349\u201355. https:\/\/doi.org\/10.1111\/j.1471-0528.2006.01210.x.","DOI":"10.1111\/j.1471-0528.2006.01210.x"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_028","doi-asserted-by":"crossref","unstructured":"Sheiner, E, Sarid, L, Levy, A, Seidman, DS, Hallak, M. Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study. J\u00a0Matern Fetal Neonatal Med 2005;18:149\u201354. https:\/\/doi.org\/10.1080\/14767050500170088.","DOI":"10.1080\/14767050500170088"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_029","doi-asserted-by":"crossref","unstructured":"Stafford, I, Dildy, GA, Clark, SL, Belfort, MA. Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol 2008;199:519.e1\u20137. https:\/\/doi.org\/10.1016\/j.ajog.2008.04.049.","DOI":"10.1016\/j.ajog.2008.04.049"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_030","doi-asserted-by":"crossref","unstructured":"Schorn, MN. Measurement of blood loss: review of the literature. J\u00a0Midwifery Womens Health 2010;55:20\u20137. https:\/\/doi.org\/10.1016\/j.jmwh.2009.02.014.","DOI":"10.1016\/j.jmwh.2009.02.014"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_031","doi-asserted-by":"crossref","unstructured":"Natrella, M, Di Naro, E, Loverro, M, Benshalom-Tirosh, N, Trojano, G, Tirosh, D, et al.. The more you lose the more you miss: accuracy of postpartum blood loss visual estimation. A systematic review of the literature. J\u00a0Matern Fetal Neonatal Med 2018;31:106\u201315. https:\/\/doi.org\/10.1080\/14767058.2016.1274302.","DOI":"10.1080\/14767058.2016.1274302"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_032","doi-asserted-by":"crossref","unstructured":"Wassen, MM, Hukkelhoven, CW, Scheepers, HC, Smits, LJ, Nijhuis, JG, Roumen, FJ. Epidural analgesia and operative delivery: a ten-year population-based cohort study in The Netherlands. Eur J Obstet Gynecol Reprod Biol 2014;183:125\u201331. https:\/\/doi.org\/10.1016\/j.ejogrb.2014.10.023.","DOI":"10.1016\/j.ejogrb.2014.10.023"},{"key":"2026051215142314128_j_jpm-2024-0567_ref_033","doi-asserted-by":"crossref","unstructured":"Lieberman, E, O\u2019Donoghue, C. Unintended effects of epidural analgesia during labor: a systematic review. Am J Obstet Gynecol 2002;186:S31\u201368. https:\/\/doi.org\/10.1067\/mob.2002.122522.","DOI":"10.1067\/mob.2002.122522"}],"container-title":["Journal of Perinatal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jpm-2024-0567\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jpm-2024-0567\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T15:21:05Z","timestamp":1778599265000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jpm-2024-0567\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,23]]},"references-count":33,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,5,29]]},"published-print":{"date-parts":[[2025,9,25]]}},"alternative-id":["10.1515\/jpm-2024-0567"],"URL":"https:\/\/doi.org\/10.1515\/jpm-2024-0567","relation":{},"ISSN":["0300-5577","1619-3997"],"issn-type":[{"value":"0300-5577","type":"print"},{"value":"1619-3997","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,23]]}}}