By PPH Foundation
For many women, surviving childbirth once is seen as reassurance for the future. But in maternal health, a previous complication can quietly become a warning sign. A history of Postpartum haemorrhage, one of the leading causes of maternal deaths, significantly increases the risk of it happening again.
Postpartum haemorrhage occurs when a woman loses excessive blood after childbirth, often within minutes or hours of delivery. While it can affect any woman, studies show that those who have experienced it before are at a much higher risk in subsequent pregnancies. This makes the second pregnancy, and any that follow, a critical period requiring heightened attention and preparedness.
The reasons for recurrence are both clinical and systemic. Conditions such as uterine atony, where the uterus fails to contract effectively after delivery, may persist across pregnancies. Other factors, including anaemia, prolonged labour, or retained placenta, can also reappear if not properly managed or monitored. In some cases, underlying health conditions further compound the risk.
Beyond clinical factors, gaps in continuity of care often mean that critical information from previous births is not fully integrated into future pregnancy management. Without proper documentation, risk profiling, and early intervention, women may enter subsequent pregnancies without the necessary safeguards in place.
Prof Ann Kihara, a gynaecologist and a Co-Lead of the End PPH Initiative, emphasizes the importance of recognizing obstetric history as a key predictor of outcomes.
“A previous history of postpartum haemorrhage is one of the strongest indicators of future risk. It should automatically trigger enhanced monitoring, early preparedness, and delivery in a well-equipped facility,” she notes.
This includes targeted antenatal care, early identification of risk factors, and clear birth planning that ensures access to skilled care and emergency services. Preventive strategies such as active management of the third stage of labour, availability of uterotonics, and readiness for rapid intervention are especially critical for women with prior complications.
There is also a need to strengthen patient awareness. Many women are not informed that a previous complication carries forward into future pregnancies. Empowering them with this knowledge can improve care-seeking behaviour and ensure that they advocate for appropriate monitoring and support.
Reducing maternal deaths requires not only managing emergencies as they occur, but also learning from past pregnancies. Because when it comes to childbirth, history does not reset. It informs risk, shapes care, and can ultimately determine survival.
Sources
World Health Organization. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva, World Health Organization, 2012.
Ford, J.B., Roberts, C.L., Simpson, J.M., Vaughan, J., Cameron, C.A. Increased Risk of Postpartum Hemorrhage in Second Pregnancy After Previous Postpartum Hemorrhage, BJOG, An International Journal of Obstetrics and Gynaecology, 2007, Volume 114, Issue 5.
Nyfløt, L.T., et al. Risk Factors for Severe Postpartum Hemorrhage, A Case-Control Study, BMC Pregnancy and Childbirth, 2017, Volume 17.
World Health Organization. Trends in Maternal Mortality 2000 to 2023, Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA Population Division. Geneva, World Health Organization, 2023.
Knight, M., et al. Recurrence of Postpartum Hemorrhage, Population-Based Study, Obstetrics and Gynecology, 2009, Volume 114, Issue 3.
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