Frequency of Post Partum Haemorrhage at Term and Its Relation with Parity
DOI:
https://doi.org/10.70749/ijbr.v3i5.2584Keywords:
Postpartum hemorrhage, Parity, Grand multiparity, Maternal morbidity, PatientsAbstract
Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide, particularly in developing countries. Objective: To determine the frequency of postpartum hemorrhage at term and assess its association with parity. Methodology: This cross-sectional study was conducted at Gynae Unit-I, PMC Hospital, Nawabshah, from 4 Sep 2024 to 4 March 2025. A total of 56 women aged 18–40 years with singleton term pregnancies were included through non-probability consecutive sampling. Women with placenta previa, bleeding disorders, or medical comorbidities were excluded. Data on maternal age, gestational age, BMI, parity, mode of delivery, booking status, and previous PPH were collected. PPH was defined as blood loss exceeding 500 mL after vaginal delivery or 1000 mL after cesarean section. Results: The mean maternal age was 28.4 ± 5.3 years, and mean gestational age at delivery was 38.7 ± 1.2 weeks. The majority of participants (37.5%) were primiparous, 35.7% multiparous, and 26.8% grand multiparous. The overall frequency of postpartum hemorrhage was 7.1% (n = 4). The incidence of PPH increased with parity, occurring in 4.7% of primiparous, 5.0% of multiparous, and 13.3% of grand multiparous women, showing a statistically significant association (p = 0.042). Higher PPH rates were also observed among cesarean deliveries (11.1%) compared to vaginal deliveries (5.3%), and among unbooked patients (12.5%) compared to booked patients (5.0%), though these differences were not statistically significant. Conclusion: The frequency of postpartum hemorrhage in this study was 7.1%, with a significant relationship between increasing parity and the risk of PPH. Grand multiparity was identified as an important risk factor. Strengthening antenatal care, ensuring institutional deliveries, and maintaining vigilance during the third stage of labor are essential measures to minimize the risk and complications associated with PPH.
Downloads
References
1. Wormer KC, Jamil RT, Bryant SB. Acute postpartum hemorrhage. StatPearls. 2023.
2. Liao YC, Tsang LLC, Yang TH, Lin YJ, Chang YW, Hsu T, et al. Unscarred uterine rupture with catastrophic hemorrhage immediately after vaginal delivery: diagnosis and management of six consecutive cases. J Matern Neonatal Med. 2023;36(2):2243366.
https://doi.org/10.1080/14767058.2023.2243366
3. Miyoshi Y, Khondowe S. Optimal parity cut-off values for predicting postpartum hemorrhage in vaginal deliveries and cesarean sections. Pan Afr Med J. 2020;37.
https://doi.org/10.11604/pamj.2020.37.336.24065
4. Nigussie J, Girma B, Molla A, Tamir T, Tilahun R. Magnitude of postpartum hemorrhage and its associated factors in Ethiopia: a systematic review and meta-analysis. Reprod Health. 2022;19(1):63.
https://doi.org/10.1186/s12978-022-01360-7
5. Linde LE, Ebbing C, Moster D, Kessler J, Baghetan E, Gissler M, et al. Recurrence of postpartum hemorrhage: maternal and paternal contribution and the effect of offspring birthweight and sex. Arch Gynecol Obstet. 2022;306(5):1807–14.
https://doi.org/10.1007/s00404-021-06374-3
6. Xu C, Zhong W, Fu Q, Yi L, Deng Y, Cheng Z, et al. Differential effects of delivery methods on progression to severe postpartum hemorrhage between Chinese nulliparous and multiparous women: a retrospective cohort study. BMC Pregnancy Childbirth. 2020;20(1):660.
https://doi.org/10.1186/s12884-020-03351-7
7. Nakagawa K, Yamada T, Cho K, Akaishi R, Kohgo Y, Hanatani K. Independent risk factors for postpartum hemorrhage. Crit Care Obstet Gynecol. 2016;2(2):10.
8. Bienstock JL, Eke AC, Hueppchen NA. Postpartum hemorrhage. N Engl J Med. 2021;384(17):1635–45.
https://doi.org/10.1056/nejmra1513247
9. Amanuel T, Dache A, Dona A. Postpartum hemorrhage and its associated factors among women who gave birth at Yirgalem general hospital, Sidama Regional State, Ethiopia. Health Serv Res Manag Epidemiol. 2021;8:1–7.
https://doi.org/10.1177/23333928211062777
10. Shamila IM, Aneesa S, Shahina I. Frequency of causes of primary postpartum hemorrhage in a tertiary care hospital. Annals. 2025;21(1):33–38.
11. Sihombing EM, Sehati ST. Relationship of parity and age with post-delivery primary bleeding. Int Arch Med Sci Public Health. 2022;3(2):63–73.
12. Shahzadi SH, Shafqat T. Frequency of postpartum haemorrhage in induced versus spontaneous labour. Pak J Med Health Sci. 2014;8(3):659–62.
13. Shazia Rafiq, Syeda Ali, Humaira Bashir, Sajilah Karim, Amtul Mateen, Sarmad Zia. Comparison of the frequency of postpartum hemorrhage in induced labour and spontaneous labour in pregnant women. Prof Med J. 2023;30(10):1264–9.
https://doi.org/10.29309/tpmj/2023.30.10.7669
14. Shah S, Hayat N, Kishwar N, Shah M. Postpartum hemorrhage in spontaneous versus induced labor in primigravida at term. J Postgrad Med Inst. 2022;36(3):166–9.
https://doi.org/10.54079/jpmi.36.3.3034
15. Tariq, M., Rafeeq, S., Jadoon, S., Ara, C., Hamid, B. S., & Rauf, I. (2025). Comparison of Frequency of Postpartum Haemorrhage in Augmented Versus Spontaneous Labour: Postpartum Haemorrhage in Augmented Versus Spontaneous Labour. Pakistan Journal of Health Sciences, 6(7), 37-42.
https://doi.org/10.54393/pjhs.v6i7.3268
16. Mubasher S, Syed S, Malik SN, Ishtiaq A, Bilqis H, Noreen H. Comparison of Frequency of Postpartum Hemorrhage in Spontaneous versus Prostaglandin Induced Labour at Term Gestation. Life and Science. 2024; 5(3): 342-349.
http://doi.org/10.37185/LnS.1.1.618
17. Majeed S, Tahira T, Younis Z, Usman S. Maternal mortality and morbidity associated with primary postpartum hemorrhage in patients at Allied Hospital Faisalabad. Indus J Biosci Res. 2025 Apr;3(4):38–42.
http://doi.org/10.70749/br.v3i4.820.
18. Zeng Y, Zhang Y, Zhen M, Lao L, Ma Y, Liu L, et al. Side effects of oxytocin in postpartum hemorrhage: a systematic review and meta-analysis. Am J Transl Res. 2022 Mar;14(3):1934–45.
19. Jones AJ, Federspiel JJ, Eke AC. Preventing postpartum hemorrhage with combined therapy rather than oxytocin alone. Am J Obstet Gynecol MFM. 2023 Feb;5(2):100731.
http://doi.org/10.1016/j.ajogmf.2022.100731.
20. Jamil S, Majeed T, Naureen R, Sheraz MA, Sikandar MZ. Incidence of postpartum hemorrhage in induced versus normal labour. Pak J Med Health Sci. 2023;17(8):57–7.
http://doi.org/10.53350/pjmhs202317857.
21. Khadim I, Hussain N, Sahar N, Khalid R. Effect of nursing care practices based on clinical interventions on the incidence of primary postpartum hemorrhage in females undergoing spontaneous vaginal delivery. Pak J Health Sci. 2023 Apr;4(4):161–5.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
