Incidence and Risk Factors of Postpartum Hemorrhage in China: A Multicenter Retrospective Study

Abstract

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide but the incidence and its risk factors in China is limited. The objective of this study is to investigate the incidence and the risk factors of PPH in Chinese women.Methods: A multi-center retrospective study of pregnant women at ≥28 weeks of gestation was conducted. Logistic regression was used to identify potential risk factors of PPH and receiver operating characteristic curve was used to evaluate the predictive performance of the identified risk factors. Subgroup analysis focusing on the number of fetus and the mode of delivery was conducted.Results: A total of 99,253 pregnant women were enrolled and 804 (0.81%) experienced PPH. The subgroup analysis revealed that the incidence of PPH was 0.75, 2.65, 1.40, and 0.31% in singletons, twin pregnancies, cesarean sections, and vaginal deliveries, respectively. Placenta previa and placenta accreta were the predominant risk factors of PPH in the overall population and all subgroups. A twin pregnancy was a risk factor for PPH regardless of the mode of delivery. Obesity, and multiparity were risk factors for PPH in both singletons and cesarean section cases, but the latter predicted a reduced probability of PPH in vaginal deliveries. Macrosomia was associated with increased risk of PPH in singletons or vaginal deliveries. In women who delivered vaginally, preeclampsia was associated with a higher risk of PPH. The areas under the curve for the overall cohort, singletons, twin pregnancies, cesarean section cases, and vaginal deliveries were 0.832 (95% confidence interval [CI] 0.813–0.851), 0.824 (95% CI 0.803–0.845), 0.686 (95% CI 0.617–0.755), 0.854 (95% CI 0.834–0.874), and 0.690 (95% CI 0.646–0.735), respectively.Conclusions: The risk factors of PPH varied slightly based on the number of fetuses and the mode of delivery, while placenta previa and placenta accreta were the two major risk factors. A combination of the identified risk factors yielded a satisfactory predictive performance in determining PPH in the overall cohort, singletons pregnancies, and women who delivered by cesarean section, whereas the performance was moderate in twin pregnancies and in women delivering vaginally.

Women and girls with haemophilia: A retrospective cohort study in China

“…The incidence of PPH (26.5%) in our cohort was much higher than that in the general female population in China (.81%), consistent with that in previous international studies 25–27 . Several guidelines suggested that antifibrinolytic drugs or coagulation factors could be applied to prevent PPH 28–30 .…”

Design of a postpartum hemorrhage and transfusion risk calculator

“…Of the 1500 women included in our study, we obtained an incidence of PPH of 28%, higher than previous studies [ 8 , [37] , [38] , [39] ], which range from 0.5% to 16%, although it is closer to that found in an Italian study [ 28 ] that reports 24%. It may be possible due to a thorough strategy for quantifying the bleed and for recording the data, taking into account that an objective measurement of bleeding is performed, which makes us think that in reality we may miss many cases of PPH when performing a subjective or visual estimation of bleeding because it could be imprecise.…”

Risk-factor model for postpartum hemorrhage after cesarean delivery: a retrospective study based on 3498 patients

“…For example, both the study from the Southern Ethiopia and Mali showed that antepartum anemia mothers are more likely to suffer from PPH 32,33 . The effect of placenta previa has also been reported in many studies 15,34,35 . A study from China found the patients with complete placenta previa had higher risk of PPH than those incomplete or no placenta previa 34 .…”

“…A study from China found the patients with complete placenta previa had higher risk of PPH than those incomplete or no placenta previa 34 . Therefore, the guidelines 36 usually recommend planned cesarean delivery for better maternal outcomes 35 . Placenta accreta refers to the penetration of placental villi into part of the muscular layer of the uterine wall.…”