<p>Annex 1: Conditions that may increase the risk for postpartum hemorrhage 1, 2, 3, 4</p><p>. placental abruption - the early detachment of the placenta from the uterus . placenta previa - the placenta covers or is near the cervical opening . overdistended uterus - excessive enlargement of the uterus due to too much amniotic fluid or a large baby, especially with birth weight over 4,000 grams (8.8 pounds) . Multiple pregnancy - more than one placenta and overdistention of the uterus . Pregnancy-induced hypertension (PIH) - high blood pressure of pregnancy . Prolonged labor . Infection . Obesity . Medications to induce labor . Medications to stop contractions (for preterm labor) . use of forceps or vacuum-assisted delivery . tear in the cervix or vaginal tissues or tear in a uterine blood vessel . bleeding into a concealed tissue area or space in the pelvis which develops into a hematoma, usually in the vulva or vaginal area . blood clotting disorders such as disseminated intravascular coagulation . placenta accreta - the placenta is abnormally attached to the inside of the uterus (a condition that occurs in one in 2,500 births and is more common if the placenta is attached over a prior cesarean scar) . placenta increta - the placental tissues invade the muscle of the uterus . placenta percreta - the placental tissues go all the way into the uterine muscle and may break through (rupture)</p><p>091d209d1e60988ae21942da84679d05.doc 1 Created by Saloni Tanna 1 http://www.mnh.jhpiego.org/best/pphactmng.asp. Maternal and Neonatal Care (MNH) Program. Last Accessed July 3, 2004.</p><p>2 http://www.e-medicine.com/med/topic3568.htm. Smith J. Postpartum Hemorrhage. Updated October 15, 2003. Last accessed July 3, 2004.</p><p>3 http://www.lancastergeneral.org/content/greystone_22651.asp. Last accessed July 4, 2004.</p><p>4 Norris TC. Management of Postpartum Hemorrhage. Am Fam Physician. 1997; 56(3): 737-8.</p>