Abstract
Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide but the incidence and its risk factors in China is limited. The objective of this study is to investigate the incidence and the risk factors of PPH in Chinese women.Methods: A multi-center retrospective study of pregnant women at ≥28 weeks of gestation was conducted. Logistic regression was used to identify potential risk factors of PPH and receiver operating characteristic curve was used to evaluate the predictive performance of the identified risk factors. Subgroup analysis focusing on the number of fetus and the mode of delivery was conducted.Results: A total of 99,253 pregnant women were enrolled and 804 (0.81%) experienced PPH. The subgroup analysis revealed that the incidence of PPH was 0.75, 2.65, 1.40, and 0.31% in singletons, twin pregnancies, cesarean sections, and vaginal deliveries, respectively. Placenta previa and placenta accreta were the predominant risk factors of PPH in the overall population and all subgroups. A twin pregnancy was a risk factor for PPH regardless of the mode of delivery. Obesity, and multiparity were risk factors for PPH in both singletons and cesarean section cases, but the latter predicted a reduced probability of PPH in vaginal deliveries. Macrosomia was associated with increased risk of PPH in singletons or vaginal deliveries. In women who delivered vaginally, preeclampsia was associated with a higher risk of PPH. The areas under the curve for the overall cohort, singletons, twin pregnancies, cesarean section cases, and vaginal deliveries were 0.832 (95% confidence interval [CI] 0.813–0.851), 0.824 (95% CI 0.803–0.845), 0.686 (95% CI 0.617–0.755), 0.854 (95% CI 0.834–0.874), and 0.690 (95% CI 0.646–0.735), respectively.Conclusions: The risk factors of PPH varied slightly based on the number of fetuses and the mode of delivery, while placenta previa and placenta accreta were the two major risk factors. A combination of the identified risk factors yielded a satisfactory predictive performance in determining PPH in the overall cohort, singletons pregnancies, and women who delivered by cesarean section, whereas the performance was moderate in twin pregnancies and in women delivering vaginally.
Highlights
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, accounting for approximately 25% of maternal deaths [1, 2]
Published studies have identified risk factors associated with PPH, including previous history of PPH, preeclampsia, prolonged labor, operative vaginal deliveries, and cesarean section [7, 12,13,14,15,16,17].the large-scale or nationwide studies mainly originate in western countries, and race may impact the incidence of PPH [18]
Vaginal delivery accounted for 54.2% of the cohort, whereas deliveries by cesarean section accounted for 45.8%
Summary
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, accounting for approximately 25% of maternal deaths [1, 2]. A nationwide study from the US revealed that the incidence of PPH increased from 2.9 to 3.2% from 2010 to 2014 [9].Research from other countries revealed similar results [5]. Published studies have identified risk factors associated with PPH, including previous history of PPH, preeclampsia, prolonged labor, operative vaginal deliveries, and cesarean section [7, 12,13,14,15,16,17].the large-scale or nationwide studies mainly originate in western countries, and race may impact the incidence of PPH [18]. Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide but the incidence and its risk factors in China is limited. The objective of this study is to investigate the incidence and the risk factors of PPH in Chinese women
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
