Factors associated with increased blood loss during delivery

Paridhi Jain, Nisha Thakur, Ashu Jain, Sunita Agarwal, Sangeeta Kamra, Shyla Jacob


Background: The present study was done to assess the blood loss during delivery even after active management of third stage of labor with oxytocin and the maternal outcomes of PPH.

Methods: We studied 100 pregnant women were either in spontaneous labor or admitted for induction of labor, underwent vaginal delivery or caesarean section in our institute. Active management of third stage of labor in all 100 cases included 10 IU intramuscular oxytocin or 10 to 20 IU intravenous in 500 ml of Ringer’s Lactate. Blood loss in all cases was noted.

Results: Of the included cases, 27 had to be given extra-uterotonics for atonic uterus, of which 12 parturient still had PPH. Atonic uterus was the cause of PPH in 11 of the 12 cases, while one case was of atonic uterus plus trauma. Half of all PPH cases responded to medical management alone, five cases had to undergo tamponade/stepwise devascularization and one case had to undergo obstetric hysterectomy. Blood loss was significantly higher in women aged more than 35 years, primigravida, not in labor, oligohydramnios or post-datism, elective LSCS, scarred uterus in and had more than 1 high risk factor. Among various high-risk conditions, significantly higher blood loss was observed in patients with chronic hypertension, gestational hypertension, pre-gestational diabetes mellitus, multipara with prior PPH, placenta previa, preeclampsia and sickle cell trait.

Conclusions: Fifteen women avoided PPH by using a reliable method of blood loss measurement and initiating interventions early. Organized PPH management protocol morbidity and mortality of the mother and neonate can be prevented.


Blood loss, Gravimetric method, Oxytocin, Post-partum hemorrhage, Pregnancy, Uterotonics

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World Health Organization (WHO) recommendations for the prevention and treatment of postpartum hemorrhage. World Health Organization, Geneva. 2012 Available at: Accessed on 25th January 2020.

Begley CM, Gyte GM, Devane D, McGuire W, Weeks A, Biesty LM. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2019;2(2):CD007412.

Durmaz A, Komurcu N. Relationship between maternal characteristics and postpartum hemorrhage: a meta-analysis study. J Nurs Res. 2018;26(5):362-72.

Lao TT, Sahota DS, Cheng YK, Law LW, Leung TY. Advanced maternal age and postpartum hemorrhage-risk factor or red herring? J Maternal-Fetal Neonat Med. 2014;27(3):243-6.

Shechter-Maor G, Sadeh-Mestechkin D, Paz YG, Halevy RS, Markovitch O, Biron-Shental T. Does parity affect pregnancy outcomes in the elderly gravida? Arch Gynecol Obstet. 2019;25:1-7.

Walker KF, Bugg GJ, Macpherson M, McCormick C, Grace N, Wildsmith C, et al. Randomized trial of labor induction in women 35 years of age or older. N Eng J Med. 2016;374(9):813-22.

Ngwenya S. Postpartum hemorrhage: incidence, risk factors, and outcomes in a low-resource setting. Inter J Women's Health. 2016;8:647.

Sharma S, Dhakal I. Cesarean versus vaginal delivery: an institutional experience. J Nepal Med Associat. 2018;56:209.

Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B. Effects of onset of labor and mode of delivery on severe postpartum hemorrhage. Am J Obst Gynecol. 2009;201:273.e1-9.

Reichman O, Gal M, Sela HY, Khayyat I, Emanuel M, Samueloff A. Grouping parturients by parity, previous-cesarean, and mode of delivery (PC-MoD classification) better identifies groups at risk for postpartum hemorrhage. Am J Perinatol. 2016;33(12):1133-7.

Nyfløt LT, Sandven I, Stray-Pedersen B, Pettersen S, Al-Zirqi I, Rosenberg M, et al. Risk factors for severe postpartum hemorrhage: a case-control study. BMC Preg Childbirth. 2017;17(1):17.

Firmin M, Carles G, Mence B, Madhusudan N, Faurous E, Jolivet A. Postpartum hemorrhage: incidence, risk factors, and causes in Western French Guiana. J Gynecol Obstet Human Reprod. 2019;48(1):55-60.

Kumar N. Postpartum hemorrhage; a major killer of woman: review of current scenario. Obstet Gynecol Int J. 2016;4(4):00116.

Bhattacharyya R, Mukherjee K. Emergency peripartum hysterectomy: indications and obstetric outcome (a 5-year review). Int Educat Res J. 2016;2(5):58-60.