Outcomes of pregnancy following postpartum haemorrhage

Objective
To assess the outcomes of pregnancy following postpartum haemorrhage (PPH) in the first pregnancy.

Design
Cohort study.

Setting
Aberdeen Maternity Hospital, Scotland, UK.

Population
All women with first deliveries recorded in the Aberdeen Maternity and Neonatal Databank (AMND) between 1986 and 2005.

Methods
All women identified from the AMND were classified into exposed and unexposed cohorts, according to whether or not they had PPH in their first delivery. They were then linked to any records of a second pregnancy.

Main outcome measures
Any second pregnancy, time to second pregnancy, early or late pregnancy loss, and prevalence of PPH in the second pregnancy.

Results
Out of 34 334 women, 10% had a PPH in their first pregnancy. There was no statistically significant difference in the time to a second pregnancy, nor in the outcome of that second pregnancy, between women who had experienced a PPH in their first pregnancy and women who had not. For women with a caesarean delivery, there was a significant reduction in the proportion conceiving again, comparing the exposed and unexposed cohorts.

Conclusions
From this cohort study we can conclude that if a PPH occurs in a first pregnancy, there is no delay in achieving a second pregnancy, and no detrimental effect on the outcome of that pregnancy. Significantly fewer women conceive a second pregnancy if they have a caesarean section in their first pregnancy that is complicated by PPH.