Risk factors for postpartum hemorrhage in a cohort of 6011 Italian women

Eugenia Biguzzi, Franca Franchi, Federico Ambrogi, Buthaina Ibrahim, Paolo Bucciarelli, Barbara Acaia, Tatjana Radaelli, Elia Biganzoli, Pier M. Mannucci

Research output: Contribution to journalArticlepeer-review


Introduction: Postpartum hemorrhage is responsible for 25% of maternal pregnancy-related deaths and it is the first cause of maternal morbidity and mortality worldwide. Objective: To define the prevalence of postpartum hemorrhage and associated risk factors after vaginal birth and to develop a risk model that improves postpartum hemorrhage prediction. Patients and methods: All women who underwent a vaginal delivery at the Obstetric Unit of a large University hospital in Milan (Italy) between July 2007and September 2009 were enrolled. Postpartum hemorrhage was defined as ≥ 500 mL blood loss. A nomogram tailored to predict postpartum hemorrhage was developed, summarizing the impact of each covariate on the probability of postpartum hemorrhage. Results: 6011 women were studied (24% had blood loss ≥ 500 mL and 4.8% ≥ 1000 mL). Nulliparity, episiotomy, retained placenta and high neonatal body weight were confirmed as risk factors for postpartum hemorrhage. The odds ratio of postpartum hemorrhage was 0.86 (95%CI 0.78-0.90) for each 1 gr/dL increase in ante-partum hemoglobin. An extensive internal validation of the developed nomogram demonstrated a good stability of the risk model. Conclusions: Low ante-partum hemoglobin is a new potentially modifiable risk factor for postpartum hemorrhage. A nomogram to predict the probability of postpartum hemorrhage is now available for external validation.

Original languageEnglish
JournalThrombosis Research
Issue number4
Publication statusPublished - Apr 2012


  • ante-partum hemoglobin
  • Post-partum hemorrhage
  • risk factors

ASJC Scopus subject areas

  • Hematology


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