Trial Registration number: ACTRN12614000870651;EudraCT number 2014‐004445‐26.
To assess the maternal characteristics andcauses associated with refractory postpartum haemorrhage (PPH).
Secondary analysis of the WHO CHAMPIONtrial data.
Twenty‐three hospitals in ten countries.
Women from the CHAMPION trial who receiveduterotonics as first‐line treatment of PPH.
We assessed the association between sociodemographic,pregnancy and childbirth factors and refractory PPH, and compared the causes ofPPH between women with refractory PPH, and women responsive to first‐line PPHtreatment.
【Main outcome measures】
Maternal characteristics; causes of PPH.
Women with labour induced or augmented withuterotonics [adjusted odds ratio (aOR) 1.35; 95% CI 1.07–1.72], with episiotomyor tears requiring suturing (aOR 1.82; 95% CI 1.34–2.48), and who had babieswith birthweights ≥3500 g (aOR 1.33; 95% CI 1.04–1.69), showedsignificantly higher odds of refractory PPH compared with the referencecategories in the multivariate analysis adjusted by centre and trial arm. Whileatony was the sole PPH cause in 53.2% (116/218) of the women in the responsivePPH group, it accounted for only 31.5% (45/143) of the causes in the refractoryPPH 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 andrefractory PPH groups, respectively.
Women with refractory PPH showed adifferent pattern of maternal characteristics and PPH causes compared withthose with first‐line treatment responsive PPH.