What are risk factors for postpartum hemorrhage (PPH)?

Updated: Jun 27, 2018
  • Author: John R Smith, MD, FACOG, FRCSC; Chief Editor: Ronald M Ramus, MD  more...
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Answer

In a large, population-based study, significant risk factors, identified using multivariable analysis, were as follows:

  • Retained placenta (OR 3.5, 95% CI 2.1-5.8)

  • Failure to progress during the second stage of labor (OR 3.4, 95% CI 2.4-4.7)

  • Placenta accreta (OR 3.3, 95% CI 1.7-6.4)

  • Lacerations (OR 2.4, 95% CI 2.0-2.8)

  • Instrumental delivery (OR 2.3, 95% CI 1.6-3.4)

  • Large-for-gestational-age (LGA) newborn (OR 1.9, 95% CI 1.6-2.4)

  • Hypertensive disorders (OR 1.7, 95%CI 1.2-2.1)

  • Induction of labor (OR 1.4, 95%CI 1.1-1.7)

  • Augmentation of labor with oxytocin (OR 1.4, 95% CI 1.2-1.7). [11]

PPH is also associated with obesity. In a study by Blomberg, the risk of atonic uterine hemorrhage rapidly increased with increasing BMI; in women with a BMI over 40, the risk was 5.2% with normal delivery and 13.6% with instrumental delivery. [12]

A study by Hanley et al reported that serotonin-norepinephrine reuptake inhibitor exposure in late pregnancy was associated with a 1.6- to 1.9-fold increased risk of postpartum hemorrhage. [13, 14]


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