Maternal and health service predictors of postpartum hemorrhage across 14 district, general and regional hospitals in Thailand

Abstract

Background: Postpartum hemorrhage (PPH) is a preventable complication, however, it remains being the leading cause of maternal mortality and morbidity worldwide including Thailand. Methods: A case-control study to examine the risk factors associated with PPH across the hospitals under the Ministry of Public Health in Thailand, was conducted. A total of 1833 patient birth records and hospital profiles including human and physical resources from 14 hospitals were obtained. A multiple logistic regression was used identifing the factors that are significantly associated with PPH. Results:The results show that the rate of PPH varied across the hospitals ranging from 1.4 to 10.6%. Women with past history of PPH were more likely to have increased risk of having PPH by 10.97 times (95% CI 2.27,53.05) compared to those who did not. The odds of PPH was higher in district and general hospitals by 14 (95% CI 3.95, 50.04) and 7 (95% CI 2.27,23.27) times respectively, compared to regional hospitals. The hospitals which had inadequate nurse midwife to patient ratio (OR 2.31,95% CI 1.08,4.92), lacked nurse midwives with working experience of 6-10 years (OR 2.35, 95% CI 1.41,3.92), as well as inadequate equipment and supplies for emergency obstetric care (OR 6.47, 95% CI 1.93,21.63), had significantly higher incidence of having PPH, respectively. Conclusions:This study provides interesting information that the rate of PPH varies across the hospitals in Thailand, in particular where essential nurse midwives, equipment, and supplies are limited. Therefore, improving health care services by allocating sufficient human and physical resources would contribute to significantly reduce this complication.

Midwifery and nurse staffing of inpatient maternity services – a systematic scoping review of associations with outcomes and quality of care

“…This finding of reduced perineal trauma was supported by studies by Gagnon et al (1997) and Hodnett et al (2002) although significance was not reached. In the case control study by Prapawichar et al (2020), hospitals which had below the standard nurse midwife to patient ratio had significantly increased odds of postpartum haemorrhage OR 2.3 (95% CI 1.08 to 4.92, p=0.03). Two studies found that maternal readmission was lower when more midwives or nurses were employed in the organisation (Gerova 2010, Kim 2015).…”

“…Six studies included only participants at low risk of complications. Three studies included only complex cases such as women having postpartum haemorrhage (Prapawichar et al, 2020), those having oxytocin in labour (Clark et al, 2014) or caesarean section (Kim et al, 2016). The majority of studies (14/21) reported only outcomes relating to labour and birth.…”

Factors Affecting the Risk of Postpartum Hemorrhage in Pregnant Women in Tibet Health Facilities

“…Improper nutrition and lack of enough physical exercise make not only pregnant women themselves gain excessive weight, but also increase the risk of macrosomia in the fetus. An oversized fetus is likely to lead to excessive distension of uterine fibers, thinning of the myometrial wall, and poor myofiber contraction, resulting in PPH [ 14 , 36 ]. During vaginal delivery, macrosomia may prolong the first and second stages of labor and result in severe perineal laceration or even perineal incision.…”

Risk Factors for Postpartum Hemorrhage in a Thai–Myanmar Border Community Hospital: A Nested Case-Control Study

“…The overall prevalence of PPH in South-Eastern Asia was previously reported at 4.88% [ 4 ]. In Thailand, the figures varied from 1.4% to 10.6%, depending on the types of health care settings [ 5 ]. The highest prevalence was usually identified in district hospitals where healthcare resources were limited, and the distribution of risk factors was different from hospitals in the urban area [ 5 , 6 ].…”