Recognizing who is at risk for postpartum hemorrhage: Targeting Anemic Women and Scoring Systems for Clinical Use

Document Type

Journal Article

Publication Date



American journal of obstetrics & gynecology MFM




Iron deficiency anemia; iron supplementation; maternal morbidity; obstetrical hemorrhage; postpartum hemorrhage; prevention


Iron deficiency anemia during pregnancy is a common concern, affecting 38% of women worldwide, and up to 50% in developing countries. It is defined differently throughout all three trimesters. It has several detrimental effects on pregnancy outcomes for both the mother and the fetus such as increasing the risk of postpartum depression, preterm delivery, cesarean delivery, preeclampsia and low birth weight. Management of iron deficiency anemia is done classically via oral iron supplementation. However, recent evidence has shown intravenous iron as a good alternative to oral iron if patients are unable to tolerate, not responding or present very late in pregnancy with new diagnosis. Management of iron deficiency anemia was demonstrated to be a protective against postpartum hemorrhage. Other ways to prevent postpartum hemorrhage include improving prediction tools that recognize who is at risk. Several risk assessment kits have been developed to estimate the risk of postpartum hemorrhage in patients and were proven to be useful in predicting patients at high risk of postpartum hemorrhage, despite limitations in low-risk groups. More comprehensive tools are also being explored, by determining clinically relevant factors through nomograms, with some proving their efficacy after implementation. Machine learning is also being utilized to form more complete tools, by including risk factors previously not accounted for. These newer tools however still require external validation before being adopted, despite promising results in testing conditions.


Obstetrics and Gynecology