Lack of blood transfusion services, anesthetic services, and operating capabilities also plays a role.
Finally, the previously mentioned comorbidities are more commonly observed in developing countries and combine to decrease a woman's tolerance of blood loss.
Other causes include placental implantation site in the lower uterine segment, bacterial toxins (eg, chorioamnionitis, endomyometritis, septicemia), hypoxia due to hypoperfusion or Couvelaire uterus in abruptio placentae, and hypothermia due to massive resuscitation or prolonged uterine exteriorization.
Recent data suggest that grand multiparity is not an independent risk factor for PPH.
Deliveries at less than 20 weeks’ gestational age are spontaneous abortions.
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Bleeding related to spontaneous abortion may have etiologies and management in common with those for PPH.
Uterine contraction and retraction leads to detachment and expulsion of the placenta.
Complete detachment and expulsion of the placenta permits continued retraction and optimal occlusion of blood vessels.
Overdistension of the uterus, either absolute or relative, is a major risk factor for atony.
Overdistension of the uterus can be caused by multifetal gestation, fetal macrosomia, polyhydramnios, or fetal abnormality (eg, severe hydrocephalus); a uterine structural abnormality; or a failure to deliver the placenta or distension with blood before or after placental delivery.