What question did this study set out to answer?

To identify risk markers for major adverse cardiovascular events following postpartum haemorrhage.

January 25, 2026

Short‐Term Major Adverse Cardiovascular Events Following Postpartum Haemorrhage: A Cohort Study (The MACEPH Study)

Key Result

Among 2069 individuals with postpartum haemorrhage, 1.93% developed major adverse cardiovascular events, primarily pulmonary oedema, linked to preeclampsia and infections.

Key Points

To identify risk markers for major adverse cardiovascular events following postpartum haemorrhage.
Conducted a retrospective cohort study across multiple countries.
Compared characteristics and interventions among participants with and without MACE.
Used multivariable logistic regression for exploratory analysis of risk markers.
Out of 2069 participants with PPH, 40 (1.93%) experienced MACE.
Most common MACE was pulmonary oedema (n = 37, 1.79%).
Participants with MACE had higher rates of preeclampsia (30% vs. 9.91%) and heart disease (7.50% vs. 1.38%).
MACE was more frequent in individuals with infections, aspirin use, and severe bleeding indicators.

Structured PICO

Population

2,069 individuals with postpartum haemorrhage (PPH) in 2012–2017 across 5 study sites in the US, Canada, the Netherlands, and Colombia.

Outcome

Major adverse cardiovascular events (MACE), including acute myocardial infarction, pulmonary oedema, cardiomyopathy, stroke, and cardiac death, observed during a hospitalisation for birth.composite

Approximately 2% of individuals with postpartum haemorrhage develop short-term MACE, predominantly pulmonary oedema, highlighting the need for increased monitoring in those with severe bleeding, infections, or lower antenatal haemoglobin.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

ABSTRACT Objective To assess risk markers for short‐term major adverse cardiovascular events (MACE) following postpartum haemorrhage (PPH). Design A retrospective cohort study. Setting Five study sites across the US, Canada, the Netherlands and Colombia. Population Individuals with PPH in 2012–2017. Main Outcome Measures MACE (including acute myocardial infarction, pulmonary oedema, cardiomyopathy, stroke, and cardiac death) observed during a hospitalisation for birth. Methods We compared characteristics and therapeutic interventions (as indicators of severe bleeding) among participants with and without MACE. We conducted an exploratory analysis using multivariable logistic regression to identify risk markers for MACE. Results Two thousand and sixty‐nine participants had PPH (US: n = 1055, Canada: n = 613, the Netherlands: n = 302, Colombia: n = 99), of whom 40 (1.93%, 95% CI 1.38, 2.62) experienced MACE. Pulmonary oedema was the most common type of event ( n = 37, 1.79%, 95% CI 1.26–2.46). Participants with MACE had more preeclampsia (30% vs. 9.91%) and heart disease (7.50% vs. 1.38%) than those without ( p < 0.05). MACE occurred more frequently in the context of infections (adjusted odds ratio aOR 6.81, 95% CI 3.24–14.33), aspirin use (aOR 4.49, 95% CI 1.07–18.85), and markers of severe bleeding, such as the need for prostaglandin F2 alpha analogues (aOR 3.16, 95% CI 1.41–7.07) and blood products (aOR 3.08, 95% CI 1.41–6.71). A higher antenatal haemoglobin was associated with less MACE (aOR 0.96, 95% CI 0.94–0.98). Conclusion About 2 in 100 persons with PPH developed MACE, mostly pulmonary oedema. Risk markers identified individuals with PPH who may require increased monitoring. Whether treating anaemia can prevent cardiovascular morbidity following PPH must be evaluated.

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