Atonic Postpartum Hemorrhage: Risk factors

Atonic Postpartum Hemorrhage arises when the uterine muscles don't contract enough to close the placental blood vessels shut after childbirth, which can lead to life-threatening blood loss after delivery. Ende HB et al. identified and quantified risk factors for atonic postpartum hemorrhage.

They searched the reputed databases to include studies on pregnant patients who developed atonic postpartum hemorrhage and reported at least one risk factor.

The investigators screened 1,239 records and included 27 studies for their review. They identified forty-seven potential risk factors for atonic postpartum hemorrhage, of which they judged 15 as definite or likely risk factors, while the remaining 32 assessed risk factors showed no association with atonic postpartum hemorrhage or had conflicting or unclear evidence.

The authors concluded that a significant proportion of postpartum hemorrhage occurs without recognized risk factors. They confirmed many risk factors for atonic hemorrhage, with the greatest risk conferred by prior postpartum hemorrhage of any etiology, placenta previa, placental abruption, uterine rupture, and multiple gestations. However, they did not include novel risk factors like hypertension, diabetes, and ethnicity in risk-assessment tools. Furthermore, the authors did not find an association between obesity and magnesium with atonic postpartum hemorrhage in their review.

Source: Gynecol. 2021 Feb 1;137(2):305-323. doi: 10.1097/AOG.0000000000004228. PMID: 33417319; PMCID: PMC8336570.