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Objective  To assess the maternal characteristics and causes associated with refractory postpartum haemorrhage (PPH).    Design  Secondary analysis of the WHO CHAMPION trial data.    Setting  Twenty‐three hospitals in ten countries.    Population  Women from the CHAMPION trial who received uterotonics as first‐line treatment of PPH.    Methods  We assessed the association between sociodemographic, pregnancy and childbirth factors and refractory PPH, and compared the causes of PPH between women with refractory PPH and women responsive to first‐line PPH treatment.    Main outcome measures  Maternal characteristics; causes of PPH.    Results  Women with labour induced or augmented with uterotonics (adjusted odds ratio [aOR] 1.35; 95% CI 1.07–1.72), with episiotomy or tears requiring suturing (aOR 1.82; 95% CI 1.34–2.48) and who had babies with birthweights ≥3500 g (aOR 1.33; 95% CI 1.04–1.69) showed significantly higher odds of refractory PPH compared with the reference categories in the multivariate analysis adjusted by centre and trial arm. While atony was the sole PPH cause in 53.2% (116/218) of the women in the responsive PPH group, it accounted for only 31.5% (45/143) of the causes in the refractory PPH group. Conversely, tears were the sole cause in 12.8% (28/218) and 28% (40/143) of the responsive PPH and refractory PPH groups, respectively. Placental problems were the sole cause in 11 and 5.6% in the responsive and refractory PPH groups, respectively.    Conclusion  Women with refractory PPH showed a different pattern of maternal characteristics and PPH causes compared with those with first‐line treatment responsive PPH.    Tweetable abstract  Women with refractory postpartum haemorrhage are different from those with first‐line treatment responsive PPH.

bjog: an international journal of obstetrics and gynaecology

Maternal characteristics and causes associated with refractory postpartum haemorrhage after vaginal birth: a secondary analysis of the WHO CHAMPION trial data