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Risk Factors for Severe Postpartum Hemorrhage in Vaginal Delivery: A Retrospective Cohort Study
Liying Wang1, Ziyi Chen1, Qingyang Zhao1
1Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing 100730, China.
Maternal-Fetal Medicine (Wolters Kluwer Health, Inc.)
|April 29, 2026
Summary
Severe postpartum hemorrhage (SPPH) risk factors in vaginal delivery include placenta issues, low platelet count, precipitate labor, and episiotomy. Early identification of these factors can aid in targeted prevention strategies for better maternal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Clinical Obstetrics
Background:
- Severe postpartum hemorrhage (SPPH) remains a significant cause of maternal morbidity and mortality worldwide.
- Identifying risk factors for SPPH in vaginal deliveries is crucial for developing effective prevention and management strategies.
Purpose of the Study:
- To investigate the independent risk factors associated with severe postpartum hemorrhage (SPPH) in singleton vaginal deliveries.
- To explore potential targeted prediction and prevention strategies for SPPH.
Main Methods:
- A retrospective cohort study was conducted involving 6784 women undergoing vaginal delivery.
- Multivariate logistic regression analysis was employed to identify independent risk factors for SPPH.
- SPPH was defined as blood loss ≥1000 mL within 24 hours or signs of hypovolemia requiring ≥4 units of red blood cell transfusion.
Main Results:
- The incidence of SPPH was 1.31%.
- Independent risk factors identified for SPPH included low-lying placenta/placenta previa (aOR=17.54), placenta accreta spectrum (aOR=5.25), thrombocytopenia (aOR=5.37), precipitate labor (aOR=3.35), and episiotomy (aOR=2.16).
- Several factors significant in univariate analysis, such as gestational age and instrumental delivery, did not remain significant in the multivariate analysis.
Conclusions:
- Placenta-related complications, thrombocytopenia, precipitate labor, and episiotomy are significant risk factors for SPPH in vaginal deliveries.
- These findings highlight the need for careful monitoring and management of women with these risk factors.
- Further validation in larger, multicenter studies is recommended due to the limited number of events observed.
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