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Postpartum haemorrhage occurrence and recurrence: a population-based study.

Jane B Ford¹, Christine L Roberts, Jane C Bell

¹Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, Sydney, NSW, Australia. jford@med.usyd.edu.au

The Medical Journal of Australia

|October 3, 2007

Summary

Women with a history of postpartum haemorrhage (PPH) face significantly elevated risks of recurrence in subsequent pregnancies. Active management during labor and hospital birth with blood cross-match facilities are crucial for these women.

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Area of Science:

Obstetrics and Gynecology
Reproductive Health
Maternal-Fetal Medicine

Background:

Postpartum haemorrhage (PPH) is a leading cause of maternal mortality worldwide.
Understanding recurrence risk is vital for effective maternal care.
Previous studies have indicated a potential for PPH recurrence, but data on consecutive pregnancies is limited.

Purpose of the Study:

To determine the incidence and recurrence rates of postpartum haemorrhage (PPH).
To analyze the risk of PPH in consecutive pregnancies among women in New South Wales.
To inform clinical practice regarding the management of women with a history of PPH.

Main Methods:

Population-based retrospective cohort study.
Utilized linked hospital discharge and birth records from New South Wales (1994-2002).
Included 125,295 women with at least two consecutive singleton pregnancies.

Main Results:

The incidence of PPH in first, second, and third pregnancies was 5.8%, 4.5%, and 4.4%, respectively.
The risk of PPH recurrence in a second consecutive pregnancy was 14.8%.
Recurrence risk increased to 21.7% in a third pregnancy after two previous PPHs, and 10.2% even with an intervening PPH-free pregnancy.

Conclusions:

Women with a history of PPH have a substantially increased risk of recurrence in subsequent pregnancies.
Active management of the third stage of labor is recommended for women with a history of PPH.
Delivery in a hospital with onsite blood cross-match facilities is advised for women with prior PPH.