Evidence map›Paper›PMID 39513665›Full record

ArticleInternational journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics2025

Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India.

Tuck Seng Cheng, Farzana Zahir, Carolin Solomi, Ashok Verma, Sereesha Rao, Saswati Sanyal Choudhury, Gitanjali Deka, Pranabika Mahanta, Swapna Kakoty, Robin Medhi and 12 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors.

Tuck Seng ChengNational Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK.ORCID https://orcid.org/0000-0003-4442-7332
Farzana ZahirDepartment of Obstetrics and Gynaecology, Assam Medical College, Dibrugarh, Assam, India.
Carolin SolomiDepartment of Obstetrics and Gynaecology, Makunda Christian Leprosy and General Hospital, Karimganj, Assam, India.
Ashok VermaDepartment of Obstetrics and Gynaecology, Dr Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh, India.
Sereesha RaoDepartment of Obstetrics and Gynaecology, Silchar Medical College and Hospital, Silchar, Assam, India.
Saswati Sanyal ChoudhuryDepartment of Obstetrics and Gynaecology, Gauhati Medical College and Hospital, Guwahati, Assam, India.
Gitanjali DekaDepartment of Obstetrics and Gynaecology, Tezpur Medical College, Tezpur, Assam, India.
Pranabika MahantaDepartment of Obstetrics and Gynaecology, Jorhat Medical College and Hospital, Jorhat, Assam, India.
Swapna KakotyDepartment of Obstetrics and Gynaecology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India.
Robin MedhiDepartment of Obstetrics and Gynaecology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India.
Shakuntala ChhabraDepartment of Obstetrics and Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India.
Anjali RaniDepartment of Obstetrics and Gynaecology, Banaras Hindu University Institute of Medical Sciences, Varanasi, Uttar Pradesh, India.
Amrit BoraDepartment of Obstetrics and Gynaecology, Sonapur District Hospital, Guwahati, Assam, India.
Indrani RoyDepartment of Obstetrics and Gynaecology, Nazareth Hospital, Shillong, Meghalaya, India.
Bina MinzDepartment of Obstetrics and Gynaecology, Sewa Bhawan Hospital Society, Basna, Chattisgarh, India.
Omesh Kumar BhartiDepartment of Health & Family Welfare, State Institute of Health and Family Welfare, Government of Himachal Pradesh, Shimla, Himachal Pradesh, India.
Rupanjali DekaMaatHRI Project, Srimanta Sankaradeva University of Health Sciences, Guwahati, Assam, India.
Charles OpondoDepartment of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.
David ChurchillDepartment of Obstetrics and Gynaecology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Marian KnightNational Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK.
Jennifer J KurinczukNational Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK.
Manisha NairNational Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK.

Funding

Medical Research Council MR/P022030/1Medical Research Council MR/W029294/1Transition Support Award MR/W029294/1
6 · The paper itself

Abstract

objectiveTo investigate whether induction/augmentation of labor in pregnant women with anemia increases the risk of postpartum hemorrhage (PPH) and whether this risk varied by indications for labor induction/augmentation and by anemia severity in pregnancy.

methodsIn a prospective cohort study of 9420 pregnant women from 13 hospitals across India, we measured hemoglobin concentrations at recruitment (≥28 weeks of gestation) and blood loss after childbirth during follow-up and collected clinical information about PPH. Clinical obstetric and childbirth information at both visits were extracted from medical records. Anemia severity in the third trimester was categorized using hemoglobin concentrations (no/mild anemia: hemoglobin ≥10 g/dL; moderate: hemoglobin 7 to 9.9 g/dL; severe: hemoglobin <7 g/dL), while PPH was defined based on blood loss volume (vaginal births: ≥500 mL or cesarean sections: ≥1000 mL) and clinical diagnosis. Indications for labor induction/augmentation were classified as clinically indicated and elective as per guidelines. We performed multivariable modified Poisson regression analyses to investigate the associations of anemia severity and indications for labor induction/augmentation, including their interaction, with PPH, adjusted for potential confounders.

resultsPPH was associated with anemia but not with indications for labor induction/augmentation. However, there was a significant interaction between the two factors in relation to PPH (P = 0.003). Among pregnant women with severe anemia, a higher risk of PPH was associated with elective (adjusted risk ratio, 3.44 [95% confidence interval, 1.29-9.18]) but not with clinically indicated (adjusted risk ratio, 1.22 [95% confidence interval, 0.42-3.55]) labor induction/augmentation. No associations were observed among pregnant women with no/mild and moderate anemia.

conclusionThe risk of PPH is higher in women who have moderate-severe anemia in late pregnancy. Induction/augmentation of labor is generally safe for women with anemia, but it can increase the risk of PPH in women with severe anemia if performed electively.

Indexed as

AnemiaLabor, InducedPostpartum HemorrhagePregnancy Complications, HematologicAdultFemaleHemoglobinsHumansIndiaPregnancyProspective StudiesRisk FactorsSeverity of Illness IndexYoung AdultHemoglobinsanemiaclinical indicationlabor induction/augmentationpostpartum hemorrhage

Identifiers

PMID39513665
PMCPMC11911977

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.