Factors associated with different levels of postpartum hemorrhage in patients experiencing blood transfusion during cesarean section

Objective: This study aimed to examine risk factors correlated with different levels of blood loss during cesarean section (CS), with an emphasis on massive obstetric hemorrhage. Methods: A retrospective study was conducted involving 271 women who experienced postpartum hemorrhage (PPH) during CS from January 2006 to December 2013: Based on the volume of blood loss during CS, these women were divided into 3 groups: low (<1500 ml), moderate (≥1500 ml and <3000 ml) and massive (≥3000 ml). All cases received packed red blood cell (PRBC) transfusions. Risk factors were compared between the low and moderate, low and massive, and moderate and massive PPH groups. Results: Women with placenta previa (PP) were more likely to have moderate bleeding (adjusted odds ratio [aOR], 2.947; 95% confidence interval [CI], 1.336-6.498) but less likely to have massive bleeding (aOR, 2.322; 95% CI, 0.854-6.310). Placenta accreta may increase the risk of moderate (aOR, 2.358; 95% CI, 1.130-5.397) or massive PPH (aOR, 3.242; 95% CI, 1.209-8.692). Pernicious placenta previa (PPP) significantly increased the risk of massive bleeding (aOR, 20.234; 95% CI, 3.617-113.250). Conclusions: Various risk factors are associated with the severity of PPH. In particular, PPP was a significant indicator of massive PPH.