Risk factors for postpartum hemorrhage in a tertiary hospital in Afghanistan

Postpartum hemorrhage (PPH) continues to be the leading cause of maternal deaths in low and middle-income countries (LMICs), including Afghanistan. Despite this, research on PPH in Afghanistan is limited. Therefore, this study aims to examine risk factors for PPH. We conducted a retrospective matched case–control study of births at the Cure Hospital maternity unit in Kabul, Afghanistan. A secondary analysis of routine data collected between January 1 and June 30, 2025, was conducted in October 2025. A case was defined as primary PPH, characterized by blood loss ≥ 500 mL in vaginal birth or ≥ 1000 mL in cesarean section in the first 24 h, or experiencing hemodynamic signs and symptoms. Three controls were selected for each case, matched by delivery type and gravidity. Multivariable logistic regression was used to explore factors associated with PPH. Ninety-one cases and 273 controls were recruited through consecutive sampling. The odds of PPH were higher in women belonging to rural areas (AOR 4.9; 95% CI 1.49–16.92), those with post-term pregnancies (AOR 3.37; 95%CI 1.04–12.23), those with abnormal labor duration (AOR 17.44; 95% CI 5.22–54.34), and those who had moderate anemia (AOR 3.2; 95% CI 1.16–8.69). On the other hand, women who utilized antenatal care (ANC) services had lower odds of PPH (AOR 0.49; 95% CI 0.26–0.90). In this study, several factors, including place of residence, post-term pregnancy, prolonged labor, maternal anemia, and antenatal care utilization, were significantly associated with PPH and warrant consideration in future policy efforts and intervention strategies aimed at improving maternal health outcomes.