PPH Risk Factor Checklist
Screen antepartum and on admission to labor & delivery. Use risk tiering (low / medium / high) to guide staffing,
IV access, blood preparation, and delivery location.
Antepartum Risk Factors
- Placenta previa or low-lying placenta
- Placenta accreta spectrum (suspected or confirmed)
- Multiple gestation
- Polyhydramnios
- Fetal macrosomia
- Previous cesarean or uterine surgery
- History of prior PPH
- Coagulopathy, thrombocytopenia, anticoagulant use
- Anemia (e.g., Hgb < 10 g/dL)
- High parity (e.g., ≥ 4 births)
- Uterine fibroids, uterine malformations
Intrapartum / Immediate Risk Factors
- Induction or augmentation of labor with high-dose oxytocin
- Prolonged labor or precipitous labor
- Chorioamnionitis or intrapartum fever
- Operative vaginal delivery
- Cesarean delivery (especially emergent)
- Uterine overdistension (multiple gestation, polyhydramnios, macrosomia)
- Magnesium sulfate use (uterine relaxation)
- Retained placenta or membranes
- Manual removal of placenta
- Uterine atony after delivery
Risk Tiers & Suggested Preparation
| Risk Tier | Typical Criteria (examples) | Suggested Preparation |
|---|---|---|
| Low Risk | No major antepartum risk factors; singleton, cephalic; no prior PPH; no previa/accreta. | Routine PPH prevention (active management of 3rd stage, uterotonic ready). Standard IV access. |
| Medium Risk | Prior PPH; moderate anemia; multiple gestation; polyhydramnios; prolonged induction; cesarean delivery without accreta features. | Ensure type & screen; at least one large-bore IV; uterotonics at bedside; PPH cart available; notify anesthesia. |
| High Risk | Suspected/confirmed placenta accreta spectrum; previa with prior cesarean; platelets < 100k; known coagulopathy; major uterine surgery; severe anemia; multiple high-risk features. | Multidisciplinary planning; two large-bore IVs; blood products available (or in room); consider IR on standby; OR delivery; invasive monitoring and massive transfusion protocol readiness. |
Criteria and thresholds should be customized to your institutional hemorrhage risk assessment tool or state perinatal quality collaborative bundle (e.g., CMQCC, AIM).