Association between pre-delivery bleeding tendency and postpartum bleeding severity: implications for rural and...

Objective: Postpartum hemorrhage (PPH) continues to be one of the significant factors causing maternal morbidity and mortality. The presence of underlying bleeding tendencies may contribute to postpartum bleeding, but they are not routinely assessed in obstetric practice. The present study aimed to assess the association between pre-delivery bleeding tendency and postpartum bleeding severity in women without known bleeding disorders. Methods: A cohort of 301 pregnant women aged 18-45 years was recruited from obstetric units between January and August 2025. A pre-delivery bleeding tendency was evaluated using certain domains of the International Society on Thrombosis and Hemostasis-Bleeding Assessment Tool (ISTH-BAT). Postpartum bleeding was assessed on the first day using the Patient-Reported Postpartum Bleeding (PRPB) tool. The data were analyzed using descriptive statistics, Pearson's correlation, ANOVA, χ² tests, and multiple linear regression. Results: There was a moderate and significant correlation between ISTH-BAT and PRPB with r=0.45 and P<0.001. The mean ISTH-BAT and PRPB scores were high among women aged 25 to 29 years. The regression analysis results indicate that ISTH-BAT scores (B=0.035, P<0.001), parity (B=0.180, P=0.006), and previous cesarean delivery (B=0.165, P=0.005) were independently associated with postpartum bleeding severity. Maternal age, type of pregnancy, and comorbid conditions were also contributory factors. Conclusion: Increased patient-reported postpartum bleeding was related to higher bleeding tendency scores. The inclusion of a structured bleeding-history assessment in antenatal care could help identify women who are at higher risk of postpartum bleeding. The findings may be particularly relevant to rural and low-resource health care institutions where laboratory-based coagulation testing is unavailable, underscoring the importance of structured bleeding-history assessment as a convenient screening method.