ArticleArchives of gynecology and obstetrics2025
Postpartum hemorrhage: risk factors for severe blood loss, surgical intervention and peripartum hysterectomy.
Article in Archives of gynecology and obstetrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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5 citing papers in PubMed.
- Risk factors for postpartum hemorrhage after pregnancy termination for fetal malformations: a retrospective study and internally validated prediction model.Archives of gynecology and obstetrics · 2026Article
- Thromboelastography combined with conventional coagulation parameters for developing a nomogram model to predict postpartum hemorrhage risk: A retrospective analysis.Pakistan journal of medical sciences · 2026Article
- Case report on resistant postpartum hemorrhage during cesarean section treated with a modified quadruple uterine belt suture technique for uterus preservation.BMC pregnancy and childbirth · 2026Article
- Ischemic pancreatitis following uterine inversion and severe postpartum hemorrhage: A case report and review of the literature.Case reports in women's health · 2025Article
- Prevalence, emerging aetiologies, and contemporary predictors of primary postpartum haemorrhage in a tertiary-level obstetric population in Nnewi, Nigeria: a pilot study.Kronika (Ljubljana, Slovenia) · 2025Article
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Abstract
purposeTo evaluate risk factors in patients presenting with postpartum hemorrhage (PPH) associated with severe blood loss (BL), surgical intervention or peripartum hysterectomy.
methodsThis retrospective cohort study included all patients who gave birth at the Hannover Medical School between January 2013 and August 2022 with PPH, defined as BL ≥ 500 ml after vaginal delivery and ≥ 1000 ml after cesarean section. The threshold for severe PPH was set at BL ≥ 1500 ml. Operative management included manual placental removal and/or aspiration/curettage, need for intrauterine balloon tamponade, uterine packing with a chitosan covered gauze or compression sutures. Hysterectomy as ultima ratio was observed separately.
resultsIn total 20.9% of 1038 patients with PPH developed severe BL. Several risk factors were identified such as nicotine abuse (aOR 3.45, 95% CI 1.57-7.59, p = 0.002), multiparity (aOR 2.12, 95% CI 1.10-4.10, p = 0.03), uterine malformation (aOR 5.09, 95% CI 1.22-21.16, p = 0.03), c-section (aOR 3.92, 95% CI 2.59-5.92, p < 0.001), placenta praevia (aOR 2.82, 95% CI 1.2-6.63, p = 0.02), abnormal placentation (aOR 9.76, 95% CI 4.22-22.56, p < 0.001) and inversion of the uterus (aOR 16.89, 95% CI 1.62-176.12, p = 0.02). More than one third of the women had a surgical intervention. Independent risk factors for an operative management of PPH were uterus malformation (aOR 5.04, 95% CI 1.22-20.91, p = 0.03), placenta praevia (aOR 2.84, 95% CI 1.23-6.53, p = 0.01), abnormal placentation (aOR 9.78, 95% CI 4.30-22.27, p < 0.001) and c-section (aOR 4.65, 95% CI 3.14-6.89, p < 0.001). Peripartum hysterectomy occurred in 1.9% of the cases and was in addition independently associated wih preeclampsia (aOR 7.50, 95% CI 1.29-43.81, p = 0.03) and amniotic infection syndrome (aOR 12.22, 95% CI 1.92-77.90, p = 0.01).
conclusionPPH is a common complication in modern obstetrics and one in five patients with pathological bleeding after birth develops severe BL. There are specific risk factors associated with a BL ≥ 1500 ml, surgical intervention and peripartum hysterectomy in PPH that should be assessed by health professionals and taken into account in the management of this postpartum complication.
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