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PPH Risk Factor Checklist

Screen antepartum and on admission to labor & delivery.

How to use Use risk tiering (low / medium / high) to guide staffing, IV access, blood preparation, and delivery location. Customize criteria and thresholds to your institutional hemorrhage risk assessment tool / state PQC bundle (e.g., CMQCC, AIM).
Checklist

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
Checklist

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 tiering

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. 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 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).

UPDATED: 2025 • For use by medical professionals. Not a substitute for institutional protocols or clinical judgment.