Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
During antenatal care, several key risk factors for postpartum haemorrhage (PPH) should be assessed. Women with these antenatal risk factors should be advised to give birth in an obstetric unit where more emergency treatment options are available NICE NG235.
- Previous obstetric history: This includes a previous PPH over 1,000 mL or one that required a blood transfusion NICE NG235.
- Placental issues: Risk factors include placenta accreta spectrum, antepartum haemorrhage, placental abruption, and low-lying placenta NICE NG235.
- Maternal health conditions: Pre-eclampsia is a significant risk factor NICE NG235. A maternal haemoglobin level below 85 g/litre at the onset of labour also increases risk NICE NG235.
- Maternal characteristics: A Body Mass Index (BMI) greater than 35 kg/mNICE NG194 is a risk factor NICE NG235. Grand multiparity, defined as parity 4 or more, is also a factor NICE NG235.
- Uterine conditions: Overdistention of the uterus, such as in multiple pregnancy or polyhydramnios, increases the risk NICE NG235. Existing uterine abnormalities, like fibroids, are also relevant NICE NG235.
- Medication use: Taking selective serotonin reuptake inhibitor (SSRI) or serotonin-noradrenaline reuptake inhibitor (SNRI) antidepressants in the month before birth may result in a small increased risk of PPH and should be considered in the bleeding and thrombotic risk assessment NICE NG235.
If a woman has risk factors for PPH, these should be highlighted in her notes, and a care plan covering the third stage of labour should be agreed upon with her NICE NG235.