Introduction
Several risk factors increase the likelihood of postpartum hemorrhage, a condition characterized by excessive bleeding after childbirth. Identifying these factors is crucial for early intervention and improved maternal outcomes.
Uterine Atony: The most significant risk factor for PPH is uterine atony, where the uterus fails to contract effectively after delivery. This condition is more common in women who have multiple gestations, a history of uterine overdistension, or a prolonged and rapid labor.
Previous PPH: A history of postpartum hemorrhage in previous pregnancies increases the risk of recurrence. Women who have previously experienced excessive bleeding are more likely to face similar challenges in subsequent deliveries.
Preeclampsia and Hypertensive Disorders: Preeclampsia, a condition characterized by hypertension and organ dysfunction during pregnancy, is associated with an increased risk of postpartum hemorrhage. Hypertensive disorders can compromise blood vessel integrity, leading to bleeding complications.
Placental Abnormalities: Certain placental abnormalities, such as placenta previa (the placenta partially or completely covers the cervix) or placental accreta (abnormal placental attachment), are significant risk factors for postpartum hemorrhage.
Multiple Gestations: Women carrying multiple fetuses have a higher risk of uterine over distension, which can lead to uterine atony and subsequent postpartum hemorrhage.
Prolonged Labor: Extended labor, particularly the second stage, increases the risk of postpartum hemorrhage. Prolonged pushing can contribute to uterine fatigue and ineffective contractions.
Operative Interventions: Certain obstetric interventions, such as cesarean section and instrumental deliveries (forceps or vacuum extraction), elevate the risk of postpartum hemorrhage due to trauma and potential disruption of normal uterine contractility.
Coagulation Disorders: Conditions affecting the coagulation system, such as disseminated intravascular coagulation (DIC), increase the risk of abnormal bleeding in the postpartum period.
Grand Multiparity: Women with a history of multiple pregnancies (grand multiparity) may experience uterine atony due to repeated stretching of the uterine muscles over successive pregnancies.
Obesity: Obese women are at an increased risk of postpartum hemorrhage, possibly due to challenges in uterine contraction and increased blood volume.
Maternal Age: Extreme maternal age, both advanced maternal age and teenage pregnancies, has been associated with an elevated risk of postpartum hemorrhage.
Polyhydramnios: Excessive amniotic fluid (polyhydramnios) is linked to uterine overdistension, increasing the likelihood of uterine atony and subsequent postpartum hemorrhage.
