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Postpartum Hemorrhagic Morbidities with Livebirth versus Stillbirth
Fabrizio Zullo1,2, Rachel Wiley3, Ipsita Ghose4
1Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy.
American Journal of Perinatology
|December 5, 2025
Summary
Stillbirth increases the risk of postpartum hemorrhagic morbidity, including significant blood loss and intensive care unit admission. This finding highlights the need for targeted interventions to reduce maternal complications following stillbirth.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Hemorrhagic Complications
Background:
- Current guidelines do not recognize stillbirth as a risk factor for postpartum hemorrhage (PPH).
- Understanding the association between stillbirth and maternal hemorrhagic morbidity is crucial for clinical practice.
Purpose of the Study:
- To investigate the likelihood of composite maternal hemorrhagic outcome (CMHO) in vaginal deliveries with stillbirth compared to livebirth.
- To identify specific hemorrhagic complications associated with stillbirth.
Main Methods:
- Retrospective cohort study of vaginal births (≥20 weeks gestation) over 24 months.
- Defined CMHO to include excessive blood loss, interventions for PPH, blood transfusion, and critical care admission.
- Used Poisson regression to calculate adjusted risk ratios, controlling for confounders.
Main Results:
- Stillbirth deliveries (1.9%) had a significantly higher risk of CMHO (32.6% vs. 16.8%) compared to livebirths.
- Adjusted analysis showed stillbirth was associated with increased risk of estimated blood loss ≥1,000 mL and ICU admission.
- No significant difference was found in rates of tamponade, surgical intervention, venous thromboembolism, hysterectomy, or maternal death.
Conclusions:
- Stillbirth is an independent risk factor for increased postpartum hemorrhagic morbidity.
- Findings support shared decision-making and can inform intervention trials to mitigate stillbirth-related complications.
- Further research is needed to develop strategies for preventing hemorrhagic morbidity in pregnancies complicated by stillbirth.
