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Purpose <p>To evaluate risk factors in patients presenting with postpartum hemorrhage (PPH) associated with severe blood loss (BL), surgical intervention or peripartum hysterectomy.</p> Methods <p>This retrospective cohort study included all patients who gave birth at the Hannover Medical School between January 2013 and August 2022 with PPH, defined as BL ≥ 500&#xa0;ml after vaginal delivery and ≥ 1000&#xa0;ml after cesarean section. The threshold for severe PPH was set at BL ≥ 1500&#xa0;ml. Operative management included manual placental removal and/or aspiration/curettage, need for intrauterine balloon tamponade, uterine packing with a chitosan covered gauze or compression sutures. Hysterectomy as ultima ratio was observed separately.</p> Results <p>In total 20.9% of 1038 patients with PPH developed severe BL. Several risk factors were identified such as nicotine abuse (aOR 3.45, 95% CI 1.57–7.59, p = 0.002), multiparity (aOR 2.12, 95% CI 1.10–4.10, p = 0.03), uterine malformation (aOR 5.09, 95% CI 1.22–21.16, p = 0.03), c-section (aOR 3.92, 95% CI 2.59–5.92, p &lt; 0.001), placenta praevia (aOR 2.82, 95% CI 1.2–6.63, p = 0.02), abnormal placentation (aOR 9.76, 95% CI 4.22–22.56, p &lt; 0.001) and inversion of the uterus (aOR 16.89, 95% CI 1.62–176.12, p = 0.02). More than one third of the women had a surgical intervention. Independent risk factors for an operative management of PPH were uterus malformation (aOR 5.04, 95% CI 1.22–20.91, p = 0.03), placenta praevia (aOR 2.84, 95% CI 1.23–6.53, p = 0.01), abnormal placentation (aOR 9.78, 95% CI 4.30–22.27, p &lt; 0.001) and c-section (aOR 4.65, 95% CI 3.14–6.89, p &lt; 0.001). Peripartum hysterectomy occurred in 1.9% of the cases and was in addition independently associated wih preeclampsia (aOR 7.50, 95% CI 1.29–43.81, p = 0.03) and amniotic infection syndrome (aOR 12.22, 95% CI 1.92–77.90, p = 0.01).</p> Conclusion <p>PPH is a common complication in modern obstetrics and one in five patients with pathological bleeding after birth develops severe BL. There are specific risk factors associated with a BL ≥ 1500&#xa0;ml, surgical intervention and peripartum hysterectomy in PPH that should be assessed by health professionals and taken into account in the management of this postpartum complication.</p>

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Postpartum hemorrhage: risk factors for severe blood loss, surgical intervention and peripartum hysterectomy

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  • 发表日期：

    2025年2月11日

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  • Emma Barth,
  • Rüdiger Klapdor,
  • Lars Brodowski,
  • Peter Hillemanns,
  • Constantin von Kaisenberg,
  • Vivien Dütemeyer

摘要

Purpose

To evaluate risk factors in patients presenting with postpartum hemorrhage (PPH) associated with severe blood loss (BL), surgical intervention or peripartum hysterectomy.

Methods

This retrospective cohort study included all patients who gave birth at the Hannover Medical School between January 2013 and August 2022 with PPH, defined as BL ≥ 500 ml after vaginal delivery and ≥ 1000 ml after cesarean section. The threshold for severe PPH was set at BL ≥ 1500 ml. Operative management included manual placental removal and/or aspiration/curettage, need for intrauterine balloon tamponade, uterine packing with a chitosan covered gauze or compression sutures. Hysterectomy as ultima ratio was observed separately.

Results

In total 20.9% of 1038 patients with PPH developed severe BL. Several risk factors were identified such as nicotine abuse (aOR 3.45, 95% CI 1.57–7.59, p = 0.002), multiparity (aOR 2.12, 95% CI 1.10–4.10, p = 0.03), uterine malformation (aOR 5.09, 95% CI 1.22–21.16, p = 0.03), c-section (aOR 3.92, 95% CI 2.59–5.92, p < 0.001), placenta praevia (aOR 2.82, 95% CI 1.2–6.63, p = 0.02), abnormal placentation (aOR 9.76, 95% CI 4.22–22.56, p < 0.001) and inversion of the uterus (aOR 16.89, 95% CI 1.62–176.12, p = 0.02). More than one third of the women had a surgical intervention. Independent risk factors for an operative management of PPH were uterus malformation (aOR 5.04, 95% CI 1.22–20.91, p = 0.03), placenta praevia (aOR 2.84, 95% CI 1.23–6.53, p = 0.01), abnormal placentation (aOR 9.78, 95% CI 4.30–22.27, p < 0.001) and c-section (aOR 4.65, 95% CI 3.14–6.89, p < 0.001). Peripartum hysterectomy occurred in 1.9% of the cases and was in addition independently associated wih preeclampsia (aOR 7.50, 95% CI 1.29–43.81, p = 0.03) and amniotic infection syndrome (aOR 12.22, 95% CI 1.92–77.90, p = 0.01).

Conclusion

PPH is a common complication in modern obstetrics and one in five patients with pathological bleeding after birth develops severe BL. There are specific risk factors associated with a BL ≥ 1500 ml, surgical intervention and peripartum hysterectomy in PPH that should be assessed by health professionals and taken into account in the management of this postpartum complication.