Postpartum haemorrhage – excessive blood loss after birth

Postpartum haemorrhage (PPH) is a leading cause of maternal death and ill health. The incidence of PPH is reported to have increased in recent decades in high-resource countries, including Australia.

Why is this so? A recently published research asked: Is the increase in postpartum haemorrhage after vaginal birth because of altered clinical practice?

It found, the combination of induction and augmentation of labor doubled the risk of severe PPH and that vaginal tears >3 cm were associated with the highest risk of severe PPH.

Maternal characteristics did not increase the risk of severe PPH, except for nulliparous and multiparous women with a previous cesarean birth.

A baby’s birthweight higher than 4000 g increased the risk of severe PPH.

It would appear that interventions do increase the risk of PPH.

A clear message for consumers is to ask the risk of having a PPH when an intervention is recommended.

A brief summary is provide below and the full article can be found at:  Is the increase in postpartum hemorrhage after vaginal birth because of altered clinical practice?: A register‐based cohort study, First published: 10 March 2021 https://doi.org/10.1111/birt.12543

The Abstract

Background

To identify risk factors for severe postpartum hemorrhage (PPH) ≥1000 ml in women giving birth vaginally.

Method

A register‐based cohort study including women with singleton pregnancies giving birth vaginally at term to a live‐born child at Aarhus University Hospital, Denmark, from January 1, 2004, to December 31, 2012. Logistic multivariable regression was used to analyze data.

Results

In 31 837 births, 1832 women (5.7%) experienced severe PPH. Maternal age, smoking during pregnancy, and prepregnancy body mass index did not increase the risk of severe PPH. However, nulliparous and multiparous women with a previous cesarean birth had an increased risk of severe PPH. Antepartum and intrapartum risk factors for severe PPH included gestational age >40 weeks, induction of labor, augmentation of labor, irregular fetal position, instrumental birth, and birthweight >4000 g. In particular, the combination of induction and augmentation of labor doubled the risk of severe PPH. Among genital tract tears, vaginal tears >3 cm were associated with the highest risk of severe PPH.

Conclusions

Maternal characteristics did not increase the risk of severe PPH, except for nulliparous and multiparous women with a previous cesarean birth. Obstetric interventions such as induction of labor, augmentation of labor, and a birthweight higher than 4000 g increased the risk of severe PPH. Larger vaginal tears presented the highest risk of severe PPH. Clinical practice with rigorous indications for obstetric interventions and timely identification and management of genital tract tears may reduce risk of severe PPH.