Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population

Obstet Gynecol. 2009 Jun;113(6):1313-1319. doi: 10.1097/AOG.0b013e3181a66b05.


Objective: To identify risk factors for immediate postpartum hemorrhage after vaginal delivery in a South American population.

Methods: This was a prospective cohort study including all vaginal births (N=11,323) between October and December 2003 and October and December 2005 from 24 maternity units in two South American countries (Argentina and Uruguay). Blood loss was measured in all births using a calibrated receptacle. Moderate postpartum hemorrhage and severe postpartum hemorrhage were defined as blood loss of at least 500 mL and at least 1,000 mL, respectively.

Results: Moderate and severe postpartum hemorrhage occurred in 10.8% and 1.9% of deliveries, respectively. The risk factors more strongly associated and the incidence of moderate postpartum hemorrhage in women with each of these factors were: retained placenta (33.3%) (adjusted odds ratio [OR] 6.02, 95% confidence interval [CI] 3.50-10.36), multiple pregnancy (20.9%) (adjusted OR 4.67, CI 2.41-9.05), macrosomia (18.6%) (adjusted OR 2.36, CI 1.93-2.88), episiotomy (16.2%) (adjusted OR 1.70, CI 1.15-2.50), and need for perineal suture (15.0%) (adjusted OR 1.66, CI 1.11-2.49). Active management of the third stage of labor, multiparity, and low birth weight were found to be protective factors. Severe postpartum hemorrhage was associated with retained placenta (17.1%) (adjusted OR 16.04, CI 7.15-35.99), multiple pregnancy (4.7%) (adjusted OR 4.34, CI 1.46-12.87), macrosomia (4.9%) (adjusted OR 3.48, CI 2.27-5.36), induced labor (3.5%) (adjusted OR 2.00, CI 1.30-3.09), and need for perineal suture (2.5%) (adjusted OR 2.50, CI 1.87-3.36).

Conclusion: Many of the risk factors for immediate postpartum hemorrhage in this South American population are related to complications of the second and third stage of labor.

Level of evidence: II.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Cohort Studies
  • Delivery, Obstetric
  • Episiotomy / adverse effects
  • Female
  • Fetal Macrosomia
  • Humans
  • Labor Stage, Second
  • Labor Stage, Third
  • Latin America
  • Placenta, Retained
  • Postpartum Hemorrhage / etiology*
  • Postpartum Hemorrhage / physiopathology
  • Postpartum Hemorrhage / prevention & control
  • Pregnancy
  • Pregnancy, Multiple
  • Prospective Studies
  • Risk Factors
  • Sutures