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About clinical trials: methodological and bioethical considerations.

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Author Spotlight: Modeling an Aspect of Preeclampsia in Female Mice Using Hypoxic Human Placenta-Derived Small Extracellular Vesicles
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Preeclampsia as a Risk Factor for Postpartum Hemorrhage: A Systematic Review and Meta-Analysis.

Natalia Valeri Gallardo Cerna1, Nayely Marisol Jara Huapaya1, Wilfor Aguirre Quispe2

  • 1Faculty of Medicine, Universidad Científica del Sur, Lima, Perú.

Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|October 25, 2025
PubMed
Summary

Preeclampsia nearly doubles the risk of postpartum hemorrhage (PPH), a major cause of maternal death. This finding highlights the need for increased monitoring of preeclampsia patients during and after delivery.

Keywords:
meta-analysispostpartum hemorrhagepreeclampsiarisk factorssystematic review

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Epidemiology

Background:

  • Postpartum hemorrhage (PPH) is a critical global health issue contributing significantly to maternal mortality.
  • Endothelial dysfunction and vascular changes associated with preeclampsia are hypothesized to increase PPH risk, but require synthesis.
  • Existing literature lacks a comprehensive analysis of the association between preeclampsia and PPH risk.

Purpose of the Study:

  • To systematically review and meta-analyze observational studies to quantify the impact of preeclampsia on the risk of postpartum hemorrhage.
  • To synthesize current evidence on the association between preeclampsia and PPH.
  • To provide evidence-based recommendations for clinical practice.

Main Methods:

  • Systematic review and meta-analysis adhering to PRISMA guidelines.
  • Inclusion of observational studies (case-control, cohort) with PPH as the primary outcome.
  • Risk of bias assessment using the Newcastle-Ottawa Scale and subgroup analyses by delivery mode and geographic region.

Main Results:

  • Twelve studies involving over 2.1 million pregnancies were analyzed.
  • Preeclampsia was associated with a significant increase in PPH risk (OR 1.95; 95% CI 1.70-2.23).
  • Risk was highest in Europe, followed by the Americas and Asia, with moderate evidence certainty and significant heterogeneity observed.

Conclusions:

  • Preeclampsia is linked to a nearly twofold increased risk of postpartum hemorrhage.
  • Clinical guidelines should recognize preeclampsia as a substantial risk factor for PPH.
  • Enhanced vigilance during delivery and postpartum care for preeclamptic patients is recommended.