Is advanced maternal age associated with increased risk of postpartum haemorrhage?

Abstract

Aims: Postpartum haemorrhage (PPH) represents one of the major causes of maternal morbidity, accounting for nearly 25% of all maternal deaths globally. With developments in assisted reproductive technology, many women are opting to have children later in life. It is well-recognised that women of advanced maternal age (AMA) are likely to experience a higher-risk pregnancy. This review aims to summarise the relationship between AMA and the increased risk of PPH.

Method: The literature search was conducted using four databases: PubMed, Scopus, MEDLINE and MIDIRS. The key search algorithm was: ‘postpartum haemorrhage OR postpartum hemorrhage [MeSH]  OR pph AND risk AND advanced maternal age OR older woman OR women over 35 years old.

Results: Research suggests that there is a clear relationship between AMA and PPH; from the age of 35 the risk of PPH increases and increases rapidly above the age of 45. This has been demonstrated across studies in multiple countries, and in both primiparous and multiparous groups.

Conclusions: AMA has been shown to be associated with a significantly increased risk of PPH. The mechanism for this relationship, however, is not well understood. Uterine atony, the failure of the myometrium to contract and compress blood vessels after delivery, is recognised as the main cause of PPH. Summarising this relationship will hopefully increase identification of women at higher risk to encourage early intervention and active management.