Predictors of primary postpartum hemorrhage among middle eastern postpartum women with vaginal delivery: A retrospective matched case-control study.

BACKGROUND

Primary postpartum hemorrhage (PPH) remains a major contributor to maternal morbidity and mortality globally. Despite improvements in maternal healthcare across the Middle East, the burden of PPH persists, and regional data on its predictors remain limited. This study aimed to examine the maternal and health service-related predictors of primary PPH among Middle Eastern women with vaginal delivery in Oman.

METHODS

A retrospective matched case-control study was conducted among 483 postpartum women who delivered vaginally at three hospitals in Oman between May 2022 and May 2024. Cases (women with PPH, ≥500 mL blood loss) were matched 1:2 with controls based on maternal age, parity, and pregnancy type. Demographic, maternal, and health service-related factors were obtained from medical records and standardized forms in collaboration with unit head nurses." Data were analyzed using descriptive statistics, univariate analyses, and logistic regression (p < 0.05).

RESULTS

The prevalence of primary PPH was 10.4 %. No significant sociodemographic differences were observed between cases and controls. Logistic regression identified six significant predictors, including retained placenta (OR = 6.484), cervical tears (OR = 48.058), perineal tears (OR = 1.473), episiotomy (OR = 2.056), anticoagulant use (OR = 2.193), and mode of delivery (OR = 1.412). The highest PPH incidence occurred at the AXXX Hospital (28.58 %), which may reflect differences in service capacity and staffing.

CONCLUSION AND CLINICAL RELEVANCE: This multi-center case-control study strengthens evidence on PPH predictors in this under-researched region. Both maternal and health service-related factors were associated with increased risk of primary PPH. Emphasis on targeted postpartum assessments, preventive measures such as selective episiotomy and perineal support during delivery, and improved clinical documentation is warranted. Policy-level actions, including investments in workforce capacity and service delivery, may further reduce PPH and improve maternal outcomes in Oman and comparable contexts.