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Postpartum Hemorrhage and Severe Maternal Morbidity

Incidences of postpartum uterine atony, invasive placentation, maternal intensive care admission, and severe maternal morbidity associated with advanced reproductive age.

111 sources ↓Last researched 2026-10-16
Hierarchy:
Natural & Life SciencesMedicine, Health & LongevityReproductive Medicine & Human FertilityAdvanced Maternal Age & Pregnancy After 40Postpartum Hemorrhage and Severe Maternal MorbidityHypertensive Disorders and Vascular ComorbiditiesMaternal Critical Care and Intensive Care UnitsNear-Miss Maternal Mortality EpidemiologyObstetric Surgical Procedures and HemostasisPlacenta Accreta Spectrum (PAS)Uterine Atony and Myometrial Senescence
+ Associated nodes:
Clinical Efficacy & Obstetric Outcomes (intersects) Clinical Nutrition and Assisted Reproductive Technology Outcomes (intersects) Hyaluronan Biochemistry & Endometrial Adhesion Mechanisms (intersects) Impact on Endometrial Receptivity and Fecundity (intersects) Micronutrient Supplementation in Ovarian Aging (intersects) Reproductive Nutrition, Dietary Patterns & Ovulatory Function (intersects) Ovarian Refractoriness and Endocrine Environment (intersects) Ovarian Reserve and Primordial Follicle Activation (intersects) Patient Stratification & Indications (intersects) Perinatal Safety & Neonatal Outcomes (intersects) Perinatal Safety and Maternal Epigenetic Outcomes (intersects) Micronutrient, Antioxidant & Mitochondrial Fertility Supplementation (intersects)
State of the Field Monograph · AI Research Synthesis5 min read · 111 sources · 19 graded findingsPeak certainty: T1

State of the Field: Postpartum Hemorrhage and Severe Maternal Morbidity

Incidences of postpartum uterine atony, invasive placentation, maternal intensive care admission, and severe maternal morbidity associated with advanced reproductive age. Grounded synthesis across 111 primary sources and 19 graded findings within Reproductive Medicine & Human Fertility → Advanced Maternal Age & Pregnancy After 40.

Synopsis · Executive Overview

Advanced maternal age (≥35 years and especially ≥40 or ≥45 years) is an independent risk factor for severe maternal morbidity, ICU admission, and postpartum hemorrhage. Maternal age ≥45 years carries an odds ratio of 2.69 (95% CI 2.34-3.06) for severe maternal morbidity compared to mothers aged 20-24. In vaginal delivery cohorts, advanced maternal age shows an odds ratio of 1.86 for postpartum hemorrhage, which is driven heavily by uterine atony, placenta previa, and hypertensive disorders. Furthermore, cesarean delivery in women aged 35 years or older elevates severe acute maternal morbidity risks (adjusted OR 2.9, 95% CI 1.9-4.4). Comorbidities such as high prepregnancy body mass index, metabolic syndrome (AOR 2.75), and low maternal hemoglobin concentrations (<110 g/L) compound these risks significantly.

Section I · Primary Literature & Evidence Synthesis

What the Peer-Reviewed Record Establishes

The primary research record in Postpartum Hemorrhage and Severe Maternal Morbidity is stratified by study design so that meta-analyses and replicated randomised controlled trials (T1–T2) carry greater epistemic weight than observational cohorts (T3–T4) or preclinical laboratory work (T5). Leading graded findings establish the core empirical baseline: [T1] High prepregnancy body mass index is associated with an increased risk of cesarean delivery and severe maternal morbidity or mortality. [83][108] [T1] Women of advanced maternal age (35 years and older) experience higher rates of adverse obstetrical outcomes, including higher rates of gestational diabetes, gestational hypertension, induced labor, and elective cesarean deliveries. [68]

Further clinical and mechanistic stratification across the literature demonstrates: [T1] Advanced maternal age is associated with worse perinatal outcomes such as preterm delivery, low birthweight, NICU admissions, low Apgar scores, and higher perinatal mortality. [68] [T1] Low maternal hemoglobin concentrations (<110 g/L) are associated with poor birth outcomes and adverse maternal events including postpartum hemorrhage and blood transfusion. [69]

Section II · Mechanisms, Interventions & Subgroup Calibration

Comparative Evaluation of Levers & Theoretical Models

When evaluated as a quantitative decision and mechanism ledger, the best-supported interventions and frameworks in Postpartum Hemorrhage and Severe Maternal Morbidity are: Active Management of the Third Stage of Labor (AMTSL) (Guideline — Reduces postpartum hemorrhage incidence by roughly 50%; landmark evidence: International obstetric guidelines and hemorrhage bundles: Critical standard of care, especially pertinent for advanced maternal age patients at higher baseline risk for atony.); Cesarean Delivery Avoidance / Trial of Labor Counseling (Targeted — Decreases severe acute maternal morbidity associated with repeat abdominal deliveries; landmark evidence: Adjusted cohort analyses (e.g., aOR 2.9 for severe morbidity with primary cesarean): Must balance against elevated baseline obstetric complications requiring prompt operative delivery.); Standardized Hemorrhage Response Teams & Drills (Supported — Shortens time to massive transfusion and intervention during severe postpartum hemorrhage; landmark evidence: Quality improvement registries and maternal safety bundles: Directly addresses human factors contributing to severe maternal morbidity.).

Within the Tree of Knowledge, this field branches into 6 specialised sub-disciplines: Hypertensive Disorders and Vascular Comorbidities (The intersection of preeclampsia, chronic hypertension, and cardiovascular strain with severe maternal morbidity in the postpartum period); Maternal Critical Care and Intensive Care Units (Analysis of ICU admission triggers, length of stay, and multi-organ failure rates among parturients aged 40 and older); Near-Miss Maternal Mortality Epidemiology (Population-level studies defining the 'near-miss' events and severe maternal morbidity (SMM) indices stratified by maternal age deciles); Obstetric Surgical Procedures and Hemostasis (Rates of emergency peripartum hysterectomy, uterine artery embolization, and massive transfusion protocols in older maternal cohorts); Placenta Accreta Spectrum (PAS) (Incidence and pathophysiology of invasive placentation, including placenta accreta, increta, and percreta, in women of advanced reproductive age).

Section III · Historical Trajectory & Contested Frontiers

Evolution of the Field, Open Debates & Active Trials

Chronologically, the field evolved through key inflection points: in 2019, Establishment of age 40 as a threshold for advanced maternal age in Barcelona (A cohort study confirmed that age 40 serves as an adequate clinical cutoff for defining increased obstetric risk in a Mediterranean population).

Active scientific debates and unresolved methodological tensions centre on: The extent to which assisted reproductive technology independently drives placental dysfunction and severe morbidity versus confounding by underlying parental age and baseline pathology remains actively debated in reproductive medicine. (contested)

Section IV · Evidentiary Gaps & Research Frontiers

Open Questions & Priorities for the Next Research Sweep

Methodological priorities and open empirical questions queued for the next research sweep across Postpartum Hemorrhage and Severe Maternal Morbidity focus on resolving subgroup effect sizes, causal mechanisms, and long-term outcomes:

  • What is the independent contribution of assisted reproductive technology versus underlying maternal age on invasive placentation and postpartum hemorrhage risk?
  • How do standardized early-warning and rapid-response protocols modify ICU admission rates specifically in postpartum women of advanced maternal age experiencing hemorrhage?
  • What are the distinct physiological mechanisms linking advanced maternal age to impaired myometrial contractility and uterine atony?
  • Prospective evaluations isolating the mechanistic link between advanced maternal age, uterine ischemia, and myometrial contractility failure
  • Multi-center trials assessing the impact of artificial intelligence-driven early warning systems on maternal ICU admission rates
  • Long-term cardiovascular and metabolic tracking of women experiencing severe maternal morbidity due to postpartum hemorrhage at age 40+

Evidence Hierarchy (Graded Claims)

  • T1Synthesis of trials
    4 (21%)
  • T2Randomised trial
    0 (0%)
  • T3Observational, large
    9 (47%)
  • T4Observational, small or case-based
    2 (11%)
  • T5Preclinical or mechanistic
    1 (5%)
  • T6Opinion, news or unverified
    3 (16%)
18 settled1 debated0 contested / frontier

Study Designs in Indexed Literature

  • Meta-analyses, Systematic Reviews & Guidelines11 (10%)
  • Randomised Controlled Trials (RCTs)12 (11%)
  • Prospective Cohorts & Clinical Registries26 (23%)
  • Observational & Clinical Case Series6 (5%)
  • Preclinical, Cellular & Computational Models1 (1%)
  • Primary Literature & Archive Records55 (50%)

Publication Timeline Velocity

Fig. 1 — Field Evidence Architecture & Publication Trajectory. Distribution of methodological study designs (111 indexed publications) and 19 extracted claims graded from T1 (meta-analyses and guidelines) to T6.

Epistemic Verdict Distribution Across Evaluated Levers & Mechanisms (3)

Guideline1 lever (33%)
Targeted1 lever (33%)
Supported1 lever (33%)
Fig. 2 — Intervention & Mechanism Epistemic Calibration. Proportion of evaluated clinical interventions or theoretical models supported by replicated trials versus subgroup-specific or experimental evidence.
Primary Citations & Landmark Studies

Key Studies Anchoring This Monograph

Synthesis & Conclusions

State of the Field Conclusions

Taken together, the evidence record in Postpartum Hemorrhage and Severe Maternal Morbidity (111 primary sources, 19 graded claims, highest certainty T1 — Synthesis of trials) separates replicated high-tier findings from early-stage hypotheses. The most robust actionable levers supported by current evidence are Active Management of the Third Stage of Labor (AMTSL) (Reduces postpartum hemorrhage incidence by roughly 50%), Cesarean Delivery Avoidance / Trial of Labor Counseling (Decreases severe acute maternal morbidity associated with repeat abdominal deliveries), Standardized Hemorrhage Response Teams & Drills (Shortens time to massive transfusion and intervention during severe postpartum hemorrhage). The 6 open research priorities detailed above guide the next autonomous literature and clinical trial sweep.

Key Quantitative Takeaways

  • 2.69: Odds ratio for severe maternal morbidity in mothers aged 45+ compared to 20-24 (Retrospective epidemiological data).
  • 3.5 per 1,000: Maternal ICU admission rate in women aged 40+ (Recent maternal health registries).
  • Active Management of the Third Stage of Labor (AMTSL) [Guideline]: Reduces postpartum hemorrhage incidence by roughly 50% — Critical standard of care, especially pertinent for advanced maternal age patients at higher baseline risk for atony.
  • Cesarean Delivery Avoidance / Trial of Labor Counseling [Targeted]: Decreases severe acute maternal morbidity associated with repeat abdominal deliveries — Must balance against elevated baseline obstetric complications requiring prompt operative delivery.
  • Open frontier in Postpartum Hemorrhage and Severe Maternal Morbidity: What is the independent contribution of assisted reproductive technology versus underlying maternal age on invasive placentation and postpartum hemorrhage risk?
2.69

Odds ratio for severe maternal morbidity in mothers aged 45+ compared to 20-24

Retrospective epidemiological data

3.5 per 1,000

Maternal ICU admission rate in women aged 40+

Recent maternal health registries

52.6%

Proportion of postpartum ICU admissions caused by obstetric hemorrhage

Clinical intensive care surveillance data

Where each lever applies

A graded decision ledger of interventions across clinical subgroups. Each row names its best landmark evidence, measured effect, clinical reading, and epistemic verdict.

Supported: RCT live-birth gainTargeted: specific subgroupGuideline: clinical consensusWeak: inconsistent/unproven gainNot supported: RCTs show no gainTrial: human trial in progressLab: preclinical / cell dish

Preparation & Transfer

Lever & MechanismBest Landmark EvidenceMeasured Effect & Clinical ReadingVerdict
Active Management of the Third Stage of Labor (AMTSL)

Prophylactic uterotonic administration, early cord clamping, and controlled cord traction to prevent uterine atony.

International obstetric guidelines and hemorrhage bundles

Effect: Reduces postpartum hemorrhage incidence by roughly 50%

Clinical reading: Critical standard of care, especially pertinent for advanced maternal age patients at higher baseline risk for atony.

Guideline

Surgical Management

Lever & MechanismBest Landmark EvidenceMeasured Effect & Clinical ReadingVerdict
Cesarean Delivery Avoidance / Trial of Labor Counseling

Minimizing primary elective cesarean sections in advanced maternal age to lower cumulative placenta accreta spectrum and severe morbidity risk.

Adjusted cohort analyses (e.g., aOR 2.9 for severe morbidity with primary cesarean)

Effect: Decreases severe acute maternal morbidity associated with repeat abdominal deliveries

Clinical reading: Must balance against elevated baseline obstetric complications requiring prompt operative delivery.

Targeted

Human Factors & Systems

Lever & MechanismBest Landmark EvidenceMeasured Effect & Clinical ReadingVerdict
Standardized Hemorrhage Response Teams & Drills

Multidisciplinary simulation drills and rapid transfusion protocols to mitigate delayed emergency resuscitation.

Quality improvement registries and maternal safety bundles

Effect: Shortens time to massive transfusion and intervention during severe postpartum hemorrhage

Clinical reading: Directly addresses human factors contributing to severe maternal morbidity.

Supported

Questions for specialist consultations

High-yield clinical and laboratory inquiries directly derived from the evidence record.

  1. What is our hospital's specific rate of severe maternal morbidity and postpartum hemorrhage for parturients over age 40?
  2. How is myometrial fatigue and uterine atony proactively managed during the third stage of labor given my age and parity?
  3. Are there specialized screening protocols in place for placenta accreta spectrum given my prior uterine surgery or assisted reproductive technology history?
  4. What rapid-response hemorrhage protocols and multidisciplinary teams are activated immediately if excessive blood loss occurs?

Queued for next research sweep

Frontier clinical trials, emerging biology, and targeted subgroup outcomes tracked by the autonomous research worker.

  • Prospective evaluations isolating the mechanistic link between advanced maternal age, uterine ischemia, and myometrial contractility failure
  • Multi-center trials assessing the impact of artificial intelligence-driven early warning systems on maternal ICU admission rates
  • Long-term cardiovascular and metabolic tracking of women experiencing severe maternal morbidity due to postpartum hemorrhage at age 40+
Historical timeline (1 milestone, 2019–2019)
  1. 2019

    Establishment of age 40 as a threshold for advanced maternal age in Barcelona

    A cohort study confirmed that age 40 serves as an adequate clinical cutoff for defining increased obstetric risk in a Mediterranean population.

Evidence by study design (19 findings across T1–T6)

Strongest support first. The bar beside each finding shows its grade.

Synthesis of trials

  1. #1 High prepregnancy body mass index is associated with an increased risk of cesarean delivery and severe maternal morbidity or mortality.

    Association Between Prepregnancy Body Mass Index and Severe Maternal… (2017); Maternal obesity and risk of cesarean delivery: a meta‐analysis (2007)

    Large cohort and meta-analytical data show clear dose-dependent risks of maternal morbidity with elevated BMI.

  2. #2 Women of advanced maternal age (35 years and older) experience higher rates of adverse obstetrical outcomes, including higher rates of gestational diabetes, gestational hypertension, induced labor, and elective cesarean deliveries.

    Advanced Maternal Age: Adverse Outcomes of Pregnancy, A Meta-Analysis. (2019)

    Meta-analysis confirms advanced maternal age is an independent risk factor for various obstetric complications.

  3. #3 Advanced maternal age is associated with worse perinatal outcomes such as preterm delivery, low birthweight, NICU admissions, low Apgar scores, and higher perinatal mortality.

    Advanced Maternal Age: Adverse Outcomes of Pregnancy, A Meta-Analysis. (2019)

    Demonstrates the cascading effect of advanced maternal age on infant health and intensive care needs.

  4. #4 Low maternal hemoglobin concentrations (<110 g/L) are associated with poor birth outcomes and adverse maternal events including postpartum hemorrhage and blood transfusion.

    Maternal hemoglobin concentrations across pregnancy and maternal and… (2019)

    Highlights anemia as a key contributor to severe maternal morbidity like hemorrhage.

Observational, large

  1. #5 Uterine atony is a primary independent risk factor for postpartum hemorrhage.

    Risk Factors for Postpartum Hemorrhage Following Vaginal Deliveries … (2025)

    Uterine atony is the most common underlying physiological cause of life-threatening postpartum hemorrhage.

  2. #6 Hemorrhage is the most frequent cause of intensive care unit admission among postpartum women, accounting for 52.6% of such cases.

    Clinical features and outcomes of peripartum obstetric patients admi… (2025)

    Establishes postpartum hemorrhage as the leading indicator for critical care requirements.

  3. #7 Maternal age of 45 years or older is an independent risk factor for severe maternal morbidity, with an odds ratio of 2.69 (95% CI 2.34-3.06) compared to mothers aged 20-24 years.

    Association of Maternal Age With Severe Maternal Morbidity and Morta… (2019)

    Provides large-scale population-based evidence quantifying the escalating risk of SMM with advanced maternal age.

  4. #8 Advanced maternal age (≥35 years) is a significant risk factor for postpartum hemorrhage, with specific contributors including uterine atony, placenta previa, and hypertensive disorders.

    Effect of Advanced Maternal Age on Pregnancy Outcome (2026); Risk Factors for Postpartum Hemorrhage Following Vaginal Deliveries … (2025); Construction of a predictive model for the risk of postpartum hemorr… (2025); Advanced maternal age (AMA) and pregnancy: a feasible but problemati… (2024)

    Multiple clinical studies identify a clear association between advanced reproductive age and increased odds of obstetric hemorrhage.

  5. #9 Advanced maternal age (age ≥ 40 years) is an independent risk factor for adverse obstetric outcomes, including prolonged hospitalization.

    Impact of aging on obstetric outcomes: defining advanced maternal ag… (2019)

    Establishes 40 years as a meaningful clinical cutoff for defining advanced maternal age in Mediterranean cohorts.

  6. #10 In a retrospective cohort study of 1,047 women with intrapartum fever, advanced maternal age was identified as a significant predictor of cesarean delivery.

    Development and Validation of Dynamic Nomograms for Predicting Deliv… (2025)

    Shows that advanced maternal age contributes to elevated rates of surgical delivery among complicated pregnancies.

  7. #11 In women aged 35 years or older, cesarean delivery is associated with a significantly increased risk of severe acute maternal morbidity compared to vaginal delivery (adjusted OR 2.9, 95% CI 1.9-4.4).

    Risk of severe maternal morbidity associated with cesarean delivery … (2019)

    Identifies an age-dependent escalation in obstetric morbidity risk linked specifically to surgical delivery methods.

  8. #12 Advanced maternal age (40+) is associated with a significantly higher incidence of maternal ICU admission (3.5 per 1,000 births) compared to younger cohorts.

    Maternal Intensive Care Unit Admission: A 10-Year Population-Based S… (2025)

    Age is identified as a critical risk factor for severe maternal morbidity necessitating intensive care.

  9. #13 In advanced maternal age primiparous women, assisted reproductive technology (ART) use is associated with a higher risk of preeclampsia compared to spontaneous conception.

    Pregnancy Outcomes Following Assisted Reproductive Technology in Adv… (2025)

    High-technology infertility treatments contribute to increased perinatal and maternal risk profiles.

Observational, small or case-based

  1. #14 Metabolic syndrome in women of advanced maternal age (≥35 years) is associated with an adjusted odds ratio (AOR) of 2.75 for severe maternal morbidity.

    Severe maternal morbidity in patients of advanced maternal age with … (2026)

    Metabolic factors independently escalate the risk profile for pregnant women over age 35.

  2. #15 The risk of maternal near miss or death is approximately 25% higher among women over 35 years of age compared to women aged 20-34.

    Severe maternal morbidity and maternal near miss in the extremes of … (2014)

    Severe maternal outcome risk is independently associated with older reproductive age.

Preclinical or mechanistic

  1. #16 Severe maternal morbidity is frequently linked to human factors including delayed emergency resuscitation, poor team coordination, and inadequate management of obstetric hemorrhage.

    Analyzing human factors affecting severe maternal morbidity (SMM) us… (2026)

    Modeling these factors suggests that system-level interventions are essential for reducing severe morbidity outcomes.

Opinion, news or unverified

  1. #17 The incidence of placenta accreta spectrum (PAS) is increasing, partly due to rising rates of cesarean sections.

    Placenta accreta spectrum-a catastrophic situation in obstetrics (2021)

    PAS is a significant complication requiring specialized multidisciplinary management.

  2. #18 Advanced maternal age is associated with an increased risk of severe COVID-19-related maternal morbidity and ICU admission.

    COVID-19 and pregnancy: is a "forgotten" disease still a threat? (2026)

    Highlights age-related vulnerability to severe maternal morbidity during systemic infection.

  3. #19 Assisted reproductive technology (ART) pregnancies are associated with placental dysfunctions, such as placenta accreta and placenta previa, due to mechanisms of abnormal trophoblast invasion.

    DebatedPlacental Dysfunction in Assisted Reproductive Pregnancies: Perinata… (2022)

    It remains scientifically unclear to what extent these outcomes are due to the ART procedures themselves versus the underlying infertility of the patients.

Where the record disagrees (1 controversy)

  • The extent to which assisted reproductive technology independently drives placental dysfunction and severe morbidity versus confounding by underlying parental age and baseline pathology remains actively debated in reproductive medicine.

    Findings #13, #19

Node lineage & crossover disciplines

Parent lineage, active node, direct child sub-branches, and associated crossover disciplines across the Tree of Knowledge.

Hierarchy:
Natural & Life SciencesMedicine, Health & LongevityReproductive Medicine & Human FertilityAdvanced Maternal Age & Pregnancy After 40Postpartum Hemorrhage and Severe Maternal MorbidityHypertensive Disorders and Vascular ComorbiditiesMaternal Critical Care and Intensive Care UnitsNear-Miss Maternal Mortality EpidemiologyObstetric Surgical Procedures and HemostasisPlacenta Accreta Spectrum (PAS)Uterine Atony and Myometrial Senescence
+ Associated nodes:
Clinical Efficacy & Obstetric Outcomes (intersects) Clinical Nutrition and Assisted Reproductive Technology Outcomes (intersects) Hyaluronan Biochemistry & Endometrial Adhesion Mechanisms (intersects) Impact on Endometrial Receptivity and Fecundity (intersects) Micronutrient Supplementation in Ovarian Aging (intersects) Reproductive Nutrition, Dietary Patterns & Ovulatory Function (intersects) Ovarian Refractoriness and Endocrine Environment (intersects) Ovarian Reserve and Primordial Follicle Activation (intersects) Patient Stratification & Indications (intersects) Perinatal Safety & Neonatal Outcomes (intersects) Perinatal Safety and Maternal Epigenetic Outcomes (intersects) Micronutrient, Antioxidant & Mitochondrial Fertility Supplementation (intersects)

Branches

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Primary indexed sources (111)

Primary scientific literature, systematic reviews, and clinical trial registrations indexed for this branch.

  1. Evaluation of Cervical Invasion and Length in Placenta Accreta Patients Sohag University, 2026, cohort
  2. Effect of Advanced Maternal Age on Pregnancy Outcome — Huda Khalid Jasim, Faiz Abdulwahid Alwaeely International Journal of Medical Sciences And Clinical Research, 2026, case control · DOI: 10.37547/ijmscr/volume06issue04-25
  3. Analyzing human factors affecting severe maternal morbidity (SMM) using fuzzy Bayesian network (FBN) — Maryam Feiz Arefi, Fereydoon Laal, Amin Babaei-Pouya et al. Frontiers in Medicine, 2026, computational · DOI: 10.3389/fmed.2025.1566625
  4. Severe maternal morbidity in patients of advanced maternal age with and without metabolic syndrome — Carolyn Robb, Rebecca Strafella, Jay Ayar et al. Archives of Gynecology and Obstetrics, 2026, cross sectional · DOI: 10.1007/s00404-026-08449-5
  5. Hematological and Coagulation Markers in Predicting Placenta Accreta Spectrum in Placenta Previa Assiut University, 2026, cohort
  6. Association between preeclampsia and eclampsia in Black women with endometriosis: a scoping review — Calbeth C. Alaribe, Kimberly D. Sapre BMC Public Health, 2026, systematic review · DOI: 10.1186/s12889-026-27739-w
  7. COVID-19 and pregnancy: is a "forgotten" disease still a threat? — Januszewski M, Ziuzia-Januszewska L, Jakimiuk AJ Ginekologia polska, 2026, unknown · DOI: 10.5603/gpl.110960
  8. Gestational Hypertension and Preeclampsia Blood Pressure (BP) Treatment Goals Less Than 140/90 vs. Less Than 160/110 mmHg: The GOALPOST Trial The George Washington University Biostatistics Center, 2026, rct
  9. Placenta-Cervical Interface Angle for Predicting Placenta Accreta Spectrum Severity Necmettin Erbakan University, 2026, cohort
  10. Cerclage Plus Progesterone vs Progesterone Alone in Twin Short Cervix National Hospital of Obstetrics and Gynecology, 2026, rct
  11. Ultrasound Scoring System for Diagnosis and Prediction of Severity and Surgical Outcomes of Placenta Accreta Spectrum Sohag University, 2026, cohort
  12. Research On Advanced Diagnostics and Management of All Pregnancies to Prevent Stillbirth (ROADMAPS) RTI International, 2026, cohort
  13. Spinal Versus General Anesthesia in Pregnancies With Placenta Accreta Spectrum: A Retrospective Comparative Study Gaziantep City Hospital, 2026, cohort
  14. Human placentation: foundations and implications for reproductive endocrinology and infertility — Elakkiya Prabaharan, David Randall Armant, Sascha Drewlo CRC Press eBooks, 2026, unknown · DOI: 10.1201/9781003466512-7
  15. Human placentation: foundations and implications for reproductive endocrinology and infertility — Elakkiya Prabaharan, David Randall Armant, Sascha Drewlo Systems Biology in Reproductive Medicine, 2025, unknown, 10 citations · DOI: 10.1080/19396368.2025.2533992
  16. Pregnancy Outcomes Following Assisted Reproductive Technology in Advanced Maternal Age Primiparous Women: A Retrospective Cohort Study. — Deng Q, Ji T, Chu G et al. International journal of women's health, 2025, cohort, 4 citations · DOI: 10.2147/ijwh.s538128
  17. Maternal Intensive Care Unit Admission: A 10-Year Population-Based Study in Slovakia — Mária Vargová, Alexandra Krištúfková, Adam Adamec et al. Bratislavské lekárske listy/Bratislava medical journal, 2025, cohort, 2 citations · DOI: 10.1007/s44411-025-00389-x
  18. Construction of a predictive model for the risk of postpartum hemorrhage in women with advanced maternal age undergoing natural childbirth. — Ren D, Yang Z, Su X et al. American journal of translational research, 2025, cohort, 1 citations · DOI: 10.62347/emny9955
  19. Clinical features and outcomes of peripartum obstetric patients admitted to the intensive care unit: A nationwide inpatient database in Japan. — Naruse S, Nakajima M, Aoki Y et al. Critical care (London, England), 2025, cohort · DOI: 10.1186/s13054-025-05597-z
  20. Mild Fetal Hydronephrosis, Gestational Diabetes and Spontaneous Resolution vs Moderate-severe Fetal Hydronephrosis, Obstructive Causes and Worse Postnatal Outcome Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 2025, cohort
  21. Risk Factors for Postpartum Hemorrhage Following Vaginal Deliveries in China: A Case-Control Study of Second Births After IUD Removal. — Shen L, Xu Y, Li B et al. International journal of women's health, 2025, case control · DOI: 10.2147/ijwh.s516263
  22. The Role of Early Nursing Intervention in the High-risk Population of Gestational Diabetes Yan Lu, 2025, rct
  23. EFFECTIVENESS OF B-LYNCH IN PRIMARY POSTPARTUM HEMORRHAGE DUE TO UTERINE ATONY — Lala Rukh Malik, Naila Bukhari Insights-Journal of Health and Rehabilitation, 2025, case series · DOI: 10.71000/3bx9e816
  24. Emergency and elective peripartum hysterectomy – the clinical experience of the Emergency University Hospital Bucharest — Evelina Stoica, Delia-Maria Grădinaru, Diana Ioana Voicu et al. Ginecologia ro, 2025, case series · DOI: 10.26416/gine.49.3.2025.11096
  25. Postpartum Hemorrhage from Uterine Atony in Resource-Limited Rural East Nusa Tenggara Indonesia: A Case Report — Nadya Bianca, Edward Sugito Manurung International Journal of Research and Review, 2025, case report · DOI: 10.52403/ijrr.20251232
  26. Observation of Strategies in Placenta Accreta Spectrum Management Assiut University, 2025, cohort
  27. Development and Validation of Dynamic Nomograms for Predicting Delivery Mode and Neonatal Intensive Care Unit Admission in Intrapartum Fever: A Retrospective Cohort Study. — Ni J, Zhang D, Ding Y et al. International journal of women's health, 2025, cohort · DOI: 10.2147/ijwh.s544623
  28. The impact of assisted reproductive technologies versus natural conception on neonatal intensive care unit admission: A retrospective cohort analysis. — Chen H, Shao H, Xu L et al. PloS one, 2025, cohort · DOI: 10.1371/journal.pone.0329943
  29. Evaluation of Clinical Outcomes and Acceptability of an Anatomical Classification for Placenta Accreta Spectrum University of California, Los Angeles, 2025, cohort
  30. Single- vs Double-Layer Cesarean Scar Repair and Myometrial Thickness Ankara City Hospital Bilkent, 2025, rct
  31. Development and Validation of a Predictive Nomogram for Postpartum Hemorrhage in Pregnant Women: A Retrospective Study. — Yang M, Yang SS, Zhang JH International journal of general medicine, 2025 · DOI: 10.2147/ijgm.s540178
  32. Advanced maternal age (AMA) and pregnancy: a feasible but problematic event. — Sparić R, Stojković M, Plešinac J et al. Archives of gynecology and obstetrics, 2024, unknown, 29 citations · DOI: 10.1007/s00404-024-07678-w
  33. Mechanisms of endometrial aging: lessons from natural conceptions and assisted reproductive technology cycles — Anat Chemerinski, Jessica Garcia de Paredes, Kristin T. Blackledge et al. Frontiers in Physiology, 2024, unknown, 28 citations · DOI: 10.3389/fphys.2024.1332946
  34. Risk Factors for Severe Maternal Morbidity Among Women Enrolled in Mississippi Medicaid — Shishir Maharjan, Swarnali Goswami, Yiran Rong et al. JAMA Network Open, 2024, 10 citations · DOI: 10.1001/jamanetworkopen.2023.50750
  35. Individual- and community-level risk factors for maternal morbidity and mortality among Native American women in the USA: a systematic review — Martin F. Celaya, Alaa Zahlan, Chelsea Rock et al. BMJ Open, 2024, systematic review, 7 citations · DOI: 10.1136/bmjopen-2024-088380
  36. A Scoping Review: Risk of Autism in Children Born from Assisted Reproductive Technology — Kelly Muller, Amelie Carballo, Karina Vega et al. Reproductive Medicine, 2024, 1 citations · DOI: 10.3390/reprodmed5040019
  37. Pregnancy following assisted reproductive technology in morbidly obese patients: assessment of feto-maternal outcomes — Bonnie B. Song, Rachel S. Mandelbaum, Zachary S. Anderson et al. Journal of Assisted Reproduction and Genetics, 2024, 1 citations · DOI: 10.1007/s10815-024-03065-1
  38. The efficacy of antenatal maternal hemogram and coagulation test parameters in predicting atony-related postpartum hemorrhage — Yeşim Cıvıl Ürkmez, Özge Deniz Ünyeli, Sebati Sinan Ürkmez et al. DergiPark (Istanbul University), 2024
  39. Maternal and Fetal Outcomes in Pregnancy in the Fifth Decade of Life and Beyond. — Johal D, Kale M, Brar S Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2024 · DOI: 10.1016/j.jogc.2024.102418
  40. Outcomes of Placenta Accreta Spectrum Disorders Surgery in Relation to Placenta Accreta Scoring Index Assiut University, 2024, cohort
  41. Peripartum hysterectomy: A 9-year population-based study in Slovakia. — Adamec A, Vargova M, Kristufkova A et al. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2024 · DOI: 10.1002/ijgo.15012
  42. Good practice recommendations on add-ons in reproductive medicine — ESHRE Add-ons working group, Kersti Lundin, J. G. Bentzen et al. Human Reproduction, 2023, unknown, 172 citations · DOI: 10.1093/humrep/dead184
  43. Placenta Accreta Spectrum — Brett D. Einerson, Jennifer B. Gilner, Lisa C. Zuckerwise Obstetrics and Gynecology, 2023, unknown, 97 citations · DOI: 10.1097/aog.0000000000005229
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