Original Article

Postpartum Hemorrhage After Vaginal Birth: An Analysis of Risk Factors

Authors: Everett F. Magann, MD, Sharon Evans, PHD, Maureen Hutchinson, RN, RM, Robyn Collins, RN, RM, BAPPSC, CHC, Bobby C. Howard, MD, John C. Morrison, MD

Abstract

Objective: To determine, in a single tertiary obstetric hospital, the incidence of and risk factors for postpartum hemorrhage (PPH) after a vaginal birth.


Methods: PPH was defined as measured blood loss greater than 1,000 mL and/or need for a transfusion.


Results: Over a 4-year period, 13,868 of 19,476 women delivered vaginally, with a PPH rate of 5.15%. Identified risk factors for PPH were Asian race, maternal blood disorders, prior PPH, history of retained placenta, multiple pregnancy, antepartum hemorrhage, genital tract lacerations, macrosomia (>4 kg), and induction of labor, as well as chorioamnionitis, intrapartum hemorrhage, still birth, compound fetal presentation, epidural anesthesia, prolonged first/second stage of labor, and forceps delivery after a failed vacuum.


Conclusions: Identification of risk factors for PPH after a vaginal delivery may afford prophylactic treatment of such women with reduction of morbidity.


Key Points


* This study found the postpartum hemorrhage rate for women delivered vaginally was 5.15%.


* Identified risk factors for postpartum hemorrhage were Asian race, maternal blood disorders, prior postpartum hemorrhage, history of retained placenta, multiple pregnancy, antepartum hemorrhage, genital tract lacerations, macrosomia (>4 kg), labor induction, chorioamnionitis, intrapartum hemorrhage, still birth, compound fetal presentation, epidural anesthesia, prolonged first/second stage of labor, and forceps delivery after a failed vacuum.

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