To explore the influence of advanced maternal age on postpartum hemorrhage.

Clinical data of 28 839 singleton pregnancies, who were ≥18 years old and delivered a baby in The Third Affiliated of Guangzhou Medical University from January 1, 2009 to December 31, 2014 were retrospective analyzed. According to maternal age at delivery, all cases were divided into advanced age group (≥35 years) and appropriate age group (18-34 years). There were 3 670 pregnancies in advanced age group and 25 169 pregnancies in appropriate age group. The incidence of postpartum hemorrhage, initial etiology and pregnant outcome were compared between the two groups. Independent sample t test, rank sum test or Chi-square tests were used for statistical analysis.

The overall postpartum hemorrhage morbidity was 3.75% (1 081/28 839). The incidence of postpartum hemorrhage in advanced age group was 4.66% (171/3 670), which was higher than that in appropriate age group 3.62% (910/25 169), with χ²=9.673, P=0.002. The initial etiology of postpartum hemorrhage in advanced age group were uterine atony (55.55%), placental factors (39.77%), soft birth canal laceration (3.51%) and coagulation defects (1.17%). The average hospitalization days and the amount of bleeding after vaginal delivery of advanced age group and appropriate age group were (9.36±0.59) d vs. (6.42±0.96) and (799.09±30.55) ml vs. (742.44±11.34) ml; there were significant difference between the two groups (P>0.05). The incidence of uterus resection, shifting to intensive care unit and red cells transfusion in advanced age group were 12.87%, 5.8% and 28.65%, respectively, which were higher than those in appropriate age group (4.51%, 2.75% and 17.25%), all P<0.05.

The pregnancy with advance age is prone to present postpartum hemorrhage, and the pregnancy outcome is poor. Uterine atony and placenta factors may be the main causes.