Objective To analyze the risk factors and effective predictive indicators for postpartum hemorrhage （PPH） in pregnant women with severe pre-eclampsia （sPE） in singleton pregnancies. The findings will serve as a valuable reference for the clinical prevention and management of PPH in these patients. Methods A retrospective analysis was conducted on 932 pregnant women with sPE at two tertiary hospitals in Guangzhou from January 1， 2016， to December 31， 2022. Among these， 95 cases were complicated by PPH. A comparative analysis was performed between the sPE group and the sPE with PPH group. Results （1） The incidence of assisted reproductive technology， intrapartum blood loss， placental abruption， elevated D-dimer levels， increased monocyte counts， and higher SIRI levels were significantly higher in the PPH group， whereas platelet counts were significantly lower （P < 0.05）. （2） The results indicated that intrapartum blood loss， D-dimer levels， and platelet counts were independently associated with PPH in pregnant women with sPE. （3） The area under the curve （AUC） for intrapartum blood loss， D-dimer， and platelet counts were 0.805， 0.717， and 0.571， respectively. The optimal cutoff value for D-dimer was determined to be 2.295 μg/mL. The combined AUC for intrapartum blood loss and D-dimer was 0.859. （4） Intrapartum blood loss values were significantly higher in the PPH group for both vaginal delivery and cesarean section （P < 0.001）. The corresponding optimal cutoff values were 285 mL and 375 mL， respectively. Conclusions Intrapartum haemorrhage， D-dimer levels， and platelet count were identified as independent risk factors for PPH in pregnant women with sPE. Specifically， pregnant women with sPE who experienced blood loss exceeding 285 mL during vaginal delivery or 375 mL during caesarean section， along with a D-dimer level greater than 2.295 μg/mL， demonstrated an increased likelihood of developing PPH. Therefore， it is crucial to enhance clinical monitoring of these relevant indicators in high-risk populations.