Incidence and Risk Factors of Postpartum Hemorrhage in Cesarean Versus Vaginal Deliveries: A Retrospective Study

Background Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality globally. The mode of delivery is a known determinant of hemorrhagic risk, yet comparative data on cesarean versus vaginal deliveries remain context-specific. Objective This study aimed to determine the incidence of PPH and evaluate its associated risk factors in cesarean and vaginal births. Methods This retrospective study was conducted at Shalamar Hospital, Lahore, Pakistan, from April 2022 to April 2025. A total of 325 postpartum patients were enrolled in the study, comprising women who delivered either by cesarean section or vaginal delivery. Data were collected from medical records using a structured proforma, which included demographic details (age, parity, and gestational age), clinical variables (anemia status, induction of labor, duration of labor, and previous cesarean delivery), and delivery characteristics. Results The overall incidence of PPH was 19.4% (n = 63), with a significantly higher rate in cesarean deliveries (26.5%) compared to vaginal deliveries (12.3%) (p < 0.01). Uterine atony was the most frequent cause in both modes. Risk factors significantly associated with PPH included maternal anemia (p < 0.001), prolonged labor (p = 0.02), and labor induction (p = 0.01). Logistic regression identified cesarean delivery (AOR: 2.4, 95% CI: 1.3-4.5), anemia (adjusted odds ratio (AOR): 3.2, 95% CI: 1.7-6.0), and prolonged labor (AOR: 1.9, 95% CI: 1.0-3.4) as independent predictors of PPH. Conclusion Cesarean delivery, maternal anemia, and prolonged labor significantly increased the risk of PPH. Preventive strategies focusing on antenatal anemia correction, cautious decision-making regarding cesarean deliveries, and timely labor management may reduce the incidence and severity of postpartum hemorrhage.