PPH

 Q: 32 years old female is admitted to ICU from Labor and Delivery (L & D). Which of the following is a higher risk factor for postpartum hemorrhage (PPH)? (select one)

 A) Retained placenta/membranes 

 B) Eclampsia 

 Answer: A

In terms of Odd Ratio (OR) retained placenta/membranes is the highest risk factors for PPH. 

Evaluating 666 PPH from 154,000 deliveries retained placenta/membranes has an OR of 3.5 whereas preeclampsia/eclampsia/HELLP syndrome has an OR of 1.7 for PPH. Other high risk factors were failure to progress during the second stage of labor (OR 3.4), morbidly adherent placenta (OR 3.3), lacerations (OR 2.4), instrumental delivery (OR 2.3), large for gestational age newborn (OR 1.9), induction of labor (OR 1.4), and prolonged first or second stage of labor (OR 1.4). 1 

There are many other risk factors for PPH which includes placenta accreta or previa, placental abruption, intrauterine fetal demise, previous history, family history, obesity, high parity, Asian or Hispanic race, multiple gestation, polyhydramnios, macrosomia, chorioamnionitis, uterine inversion, leiomyoma, Couvelaire uterus, inherited bleeding diathesis, uterine relaxants, and use of SSRIs by a patient.

#ob-Gyn

References:

1. Sheiner E, Sarid L, Levy A, et al. Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study. J Matern Fetal Neonatal Med 2005; 18:149. 

2. Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg 2010; 110:1368. 

3. Kramer MS, Berg C, Abenhaim H, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol 2013; 209:449.e1. 

4. Sharp GC, Saunders PT, Greene SA, et al. Intergenerational transmission of postpartum hemorrhage risk: analysis of 2 Scottish birth cohorts. Am J Obstet Gynecol 2014; 211:51.e1. 

5. Bruning AH, Heller HM, Kieviet N, et al. Antidepressants during pregnancy and postpartum hemorrhage: a systematic review. Eur J Obstet Gynecol Reprod Biol 2015; 189:38. 

6. Skalkidou A, Sundström-Poromaa I, Wikman A, et al. SSRI use during pregnancy and risk for postpartum haemorrhage: a national register-based cohort study in Sweden. BJOG 2020; 127:1366.