Journal of Shandong University (Health Sciences) ›› 2026, Vol. 64 ›› Issue (5): 61-66.doi: 10.6040/j.issn.1671-7554.0.2026.0013

• Clinical Medicine • Previous Articles     Next Articles

Risk factors and early intervention for postpartum hemorrhage caused by lower uterine segment atony

LIU Huijun1, WU Zhaoting2, WANG Yuli1, XU Mingyang3, LIU Xiao1, KANG Yan2, WANG Hongmei1   

  1. 1. Department of Obstetrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China;
    2. Department of Obstetrics, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan 250014, Shandong, China;
    3. Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
  • Online:2026-05-13 Published:2026-05-13

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Abstract: Objective To investigate the incidence, risk factors of postpartum hemorrhage caused by lower segment atony(PPH-LSA)after vaginal delivery and the impact of its early identification and intervention on improving adverse postpartum outcomes. Methods Clinical data of all consecutive term singleton vaginal deliveries in two tertiary perinatal centers from July 2020 to June 2025(n=42,253)were retrospectively analyzed. Obstetric characteristics of women with postpartum hemorrhage(PPH, n=1,408)were extracted. The incidence of PPH-LSA was compared between the severe PPH group(≥1,000 mL, n=428)and the mild PPH group(500-1,000 mL, n=980). Binary logistic regression analysis was performed to identify independent risk factors for PPH-LSA. The effects of early intervention(within 30 minutes after placental delivery, n=214)versus late intervention(after 30 minutes after placental delivery, n=53)on postpartum blood loss volume and laparotomy rate were further evaluated. Results A total of 42,253 term singleton vaginal deliveries were included, among whom 1,408 women(3.33%)were diagnosed with PPH. Of these, 267 cases(18.96%)were classified as PPH-LSA. The incidence of PPH-LSA in the severe PPH group(24.53%)was significantly higher than that in the mild PPH group(16.53%)(P<0.001). Binary logistic regression analysis revealed that advanced age(per 5-year increment)(OR=1.245, 95%CI: 1.040-1.491), uterine scar(OR=18.760, 95%CI: 2.155-163.282), macrosomia(OR=1.801, 95%CI: 1.031-3.146), and low-lying placenta(OR=5.426, 95%CI: 1.796-16.389)were independent risk factors for PPH-LSA(P<0.05). Compared with the late intervention group, the early intervention group had significantly lower rates of red blood cell transfusion(19.16% vs. 39.62%), laparotomy(0% vs. 5.66%), and severe blood loss(≥2,000 mL, 1.87% vs. 13.21%)(P<0.05). One case of hysterectomy followed by maternal death occurred in the late intervention group. Conclusion Approximately one-fifth of PPH cases after vaginal delivery are attributed to PPH-LSA. Advanced age, uterine scar, macrosomia, and low-lying placenta are independent risk factors for this condition. Early identification and targeted intervention can significantly reduce the risk of severe adverse maternal outcomes.

Key words: Postpartum hemorrhage, Lower segment atony, Risk factors, Early intervention

CLC Number: 

  • R714
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