Predictors of Postpartum Hemorrhage Following Repeat Cesarean Section: A Retrospective Cohort Study

Postpartum hemorrhage (PPH) is a major obstetric emergency that contributes substantially to maternal morbidity following cesarean delivery. The identification of high-risk patients undergoing repeat cesarean sections may help improve perioperative preparedness and maternal outcomes. The present study aimed to identify predictors of PPH following repeated cesarean sections.

A retrospective cohort study was conducted in the Department of Obstetrics and Gynecology on 200 women who underwent repeat cesarean section between January 2020 and December 2025. Demographic, obstetric, and intraoperative data were retrieved from archived medical records. PPH was defined as blood loss ≥1000 mL during or within 24 hours after cesarean delivery or the requirement for transfusion/intervention. Statistical analysis was performed using univariate analysis and multivariable logistic regression to identify independent predictors of PPH. Adjusted odds ratios (aORs) with 95% confidence intervals were calculated, and a p-value < 0.05 was considered statistically significant.

Among the 200 patients, PPH was observed in 72 (36.0%), while 128 (64.0%) did not develop hemorrhage. Women with PPH demonstrated significantly higher body mass index (BMI) (28.3 ± 3.9 kg/m² vs. 25.9 ± 3.3 kg/m²), a greater number of previous cesarean sections (2.1 ± 0.8 vs. 1.6 ± 0.6), lower antenatal hemoglobin levels (9.6 ± 1.4 g/dL vs. 10.7 ± 1.4 g/dL), and prolonged surgery duration (74.8 ± 19.6 min vs. 55.2 ± 14.3 min) (p < 0.001). Placenta previa or placental abnormalities, intraoperative adhesions, and emergency cesarean sections were significantly associated with hemorrhage. Multivariable logistic regression identified placenta previa or placental abnormality (aOR = 3.33), intraoperative adhesions (aOR = 2.50), ≥3 previous cesarean sections (aOR = 2.00), emergency cesarean section (aOR = 1.80), higher parity, elevated BMI, prolonged surgery duration, and lower antenatal hemoglobin level as independent predictors of PPH (all p < 0.05).

PPH following repeated cesarean sections is strongly associated with multiple maternal and intraoperative risk factors. Early identification of high-risk patients may facilitate improved surgical planning, preventive interventions, and optimized maternal care.