Postpartum haemorrhage occurrence and recurrence: a population-based study

To determine the risk of occurrence and recurrence of postpartum haemorrhage (excessive bleeding after childbirth) among women having at least two consecutive pregnancies.

Population-based study using longitudinally linked hospital discharge and birth records from New South Wales for the period 1 January 1994 to 31 December 2002.

All 125,295 women having at least a first and second pregnancy resulting in a singleton birth at > 400 g or > or = 20 weeks' gestation in the study period.

Risk of occurrence of postpartum haemorrhage (PPH) in any pregnancy, and of recurrence of PPH in subsequent (second and third) pregnancies.

5.8% of women (7327/125,295) had a PPH in their first pregnancy, and 4.5% (5318/117,968) had a first PPH in their second pregnancy. Among the 23,095 women who had three pregnancies in the study period, 4.4% (908/20,839) had a first PPH in their third pregnancy. The risk of recurrence in a second consecutive pregnancy was 14.8% (1082/7327), and in a third consecutive pregnancy (after two previous PPHs) was 21.7% (43/198); even with an intervening pregnancy with no PPH (ie, PPH in the first and third pregnancies only), the risk for the third pregnancy was 10.2% (111/1085).

These consistently elevated risks of recurrence highlight the need for women with a history of PPH to have active management of the third stage of labour and to give birth in a hospital that has onsite blood cross-match facilities.