Predictors of severity in primary postpartum hemorrhage

Abstract

Previous cesarean delivery, prolonged labor, oxytocin augmentation and emergency cesarean delivery are strongest predictors of severe blood loss in women with PPH. In addition, uterine atony and abnormal placentation are the etiologies significantly associated with severe PPH.

Maternal, Labor, Delivery, and Perinatal Outcomes Associated with Placental Abruption: A Systematic Review

“…Estimates of PPH risk ranged from 1.62 to 17.9 (incidence: 0.4-50%) and five of eight studies reported a significantly elevated risk in the setting of abruption. 2,20,[32][33][34] Of the three studies reporting nonsignificant associations, one did not provide a definition of hemorrhage 15 and the other two were examining risk of severe hemorrhage versus nonsevere hemorrhage, 35,36 which likely explains the conflicting findings. Variation in risk estimates in the remaining studies is likely due to specification of subpopulations (only cesarean deliveries, only emergent cesareans, etc.…”

Risk factors for transfusion in cesarean section deliveries at a tertiary hospital

“…Previous studies primarily focused on the predictors of PPH before delivery. Factors including maternal age, multiparity, abnormal placentation, placental abruption, severe preeclampsia, previous cesarean delivery, fetal macrosomia, and uterine fibroids have been associated with PPH . Previous studies confirm that placental abnormalities are the most common factor leading to an emergency peripartum hysterectomy …”

“…Factors including maternal age, multiparity, abnormal placentation, placental abruption, severe preeclampsia, previous cesarean delivery, fetal macrosomia, and uterine fibroids have been associated with PPH. [8][9][10][11][12][13] Previous studies confirm that placental abnormalities are the most common factor leading to an emergency peripartum hysterectomy. 14 Patients with PPH who require a transfusion mainly suffer from more severe hemorrhage, which may rapidly worsen and result in adverse outcomes such as peripartum hysterectomy and maternal death.…”

Customised management of the third stage of labour

“…The increased background rate is most likely due to growing prevalence of known risk factors such as advanced maternal age, rising maternal obesity, increased caesarean section rates, higher multiple pregnancy rates, and a greater proportion of induced labours . In particular, induction or augmentation of labour is known to be a significant risk factor for PPH . Exposure to synthetic oxytocin during labour is thought to desensitise the uterine myometrium to further oxytocin boluses via oxytocin receptor down‐regulation .…”