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Postpartum haemorrhage--a continuing problem.

L Gilbert, W Porter, V A Brown

    British Journal of Obstetrics and Gynaecology
    |January 1, 1987
    PubMed
    Summary
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    Postpartum hemorrhage (PPH) risk increases with first-time pregnancy, induced labor, forceps delivery, and longer labor stages. Changes in practice have led to a rise in PPH cases.

    Area of Science:

    • Obstetrics and Gynecology
    • Maternal Health
    • Clinical Obstetrics

    Background:

    • Postpartum hemorrhage (PPH) remains a significant cause of maternal morbidity and mortality.
    • Recent trends suggest an increase in PPH incidence, necessitating identification of contributing factors.
    • Understanding risk factors is crucial for effective prevention and management strategies.

    Purpose of the Study:

    • To identify labor characteristics associated with an increased risk of postpartum hemorrhage (PPH) in singleton vaginal deliveries.
    • To compare labor parameters in women experiencing PPH versus those with normal blood loss.
    • To inform clinical practice and potentially mitigate the rising incidence of PPH.

    Main Methods:

    • Retrospective case-control study comparing 86 women with PPH (blood loss >500 ml) to 351 controls (blood loss <350 ml).

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  • Analysis focused on labor characteristics, including parity, induction methods, delivery mode, labor duration, and prophylactic oxytocics.
  • Statistical comparison of risk factors between the PPH and control groups.

    • Main Results:

    • Significant risk factors for PPH included primiparity, labor induction (amniotomy/oxytocin), forceps delivery, and prolonged first and second labor stages.
    • Use of oxytocin alone as a prophylactic oxytocic was associated with higher PPH risk compared to syntometrine.
    • Epidural analgesia was identified as an indirect contributor to increased PPH risk.

    Conclusions:

    • Several modifiable labor characteristics are significantly associated with an increased risk of postpartum hemorrhage.
    • Changes in labor ward practices over the past two decades may have contributed to the re-emergence of PPH as a critical issue.
    • Targeted interventions addressing identified risk factors could help reduce PPH incidence and improve maternal outcomes.