Risk of postpartum hemorrhage among Native American women

OBJECTIVE: To assess whether Native American women have an increased risk of postpartum hemorrhage (PPH) after vaginal delivery. METHODS: In a retrospective study, medical charts were reviewed for patients who delivered vaginally at Rehoboth McKinley Hospital in Gallup, NM, USA, between June 1, 2009, and June 30, 2012. Ethnic origin had been determined by self-report. PPH was defined as a visually estimated blood loss of more than 500 mL. Multivariable logistic analysis was undertaken to identify factors independently associated with PPH. RESULTS: Among 1062 eligible patients, 751 (70.7%) were Native American and 311 (29.3%) were non-native (white, African American, or Hispanic). A significantly higher proportion of Native Americans than non-native women developed PPH (87 11.6% vs 22 7.0%; P=0.02). In multivariable analysis, Native American ethnic origin was an independent predictor of PPH (odds ratio 1.8, 95% confidence interval 1.1-3.0; P=0.02). In a comparison with white women only, PPH was significantly more frequent among Native American women (87/751 11.6% vs 13/194 6.7%; P=0.01). CONCLUSION: Native American women have a higher risk of PPH after vaginal delivery than do non-native women.