Postpartum haemorrhage in Zimbabwe: a risk factor analysis

Abstract

To identify risk factors associated with postpartum haemorrhage (PPH) in order to improve the effectiveness of antenatal screening. A population-based case control study. Harare, Zimbabwe. Two groups of women, one group consisting of those with postpartum haemorrhage after a normal vaginal delivery and the other of women with normal unassisted vaginal delivery without PPH. Data abstracted from the medical records; relative risks were estimated by multivariate logistic regression. Low parity, advanced maternal age, and antenatal hospitalisation were among the strongest risk factors, with more modest associations for history of poor maternal or perinatal outcomes and borderline anaemia at the time of booking. No association with grand multiparity was found. These findings confirm the importance of previously recognised factors such as low parity, poor obstetric history, anaemia, and prolonged labour, but call into question the significance of grand multiparity. Previously undocumented factors such as maternal age greater than 35 years and occiput posterior head position emerged as predictors worthy of further investigation.