Prevalence and Risk Factors of Severe Postpartum Hemorrhage: a Retrospective Cohort Study

Abstract

Background: Although maternal deaths are rare in developed regions, the morbidity associated with severe postpartum hemorrhage remains a major problem. To provide new insight into severe postpartum hemorrhage, we analyzed data of women giving birth in Guangzhou Medical Centre for Critical Pregnant Women, which receiveda large quantity of critically ill obstetric patients from other hospitals of Southern China. Methods: In this study, we conducted a retrospective cohort by using the criteria of severe maternal morbidities, which was defined by estimation of blood loss volume and use of blood transfusion≥4 units, to determine the prevalence, risk factors and short-term complications of severe postpartum hemorrhage. Results: Severe postpartum hemorrhage was observed in 532 mothers (1.56%) among the total population of 34 178 mothers. Placental related cause (55.83%) was the major identified cause of severe postpartum hemorrhage, while uterine atony without associated retention of placental tissues accounted for 38.91%. The risk factors for severe postpartum hemorrhage were maternal age<18 years, previous cesarean section, history of postpartum hemorrhage, conception through in vitro fertilization, pre-delivery anemia, stillbirth, prolonged labor, placenta previa, placental abruption, placenta accrete spectrum and macrosomia. The prevalence rates of admission to ICU, hysterectomy, acute renal failure and sepsis were significantly higher in women with severe postpartum hemorrhage. Conclusion:The results of this study suggested that severe postpartum hemorrhagecould be adopted as an indicator to assess the quality of obstetric care because of its severity and potential lethality. Extra vigilance during the antenatal and peripartum periods is needed to identify women who have risk factors and enable early intervention to prevent severe postpartum hemorrhage. It’s important to remember that we have to prepare for all mothers giving birth, as some get severe postpartum hemorrhagewithout any known risk factors.

Risk factors for postpartum hemorrhage caused by uterine atony

“…The OR value in this study means that patients with anemia are five times more at risk of postpartum hemorrhage due to uterine atony than patients who are not anemic. The results of this study are in line with the results of research by Liu C and coauthors and Julizar M. and Sukandar H, their research also found that mothers with anemia were at risk for uterine atony compared to mothers who did not have anemia [Julizar M, Sukandar H, 2019;Liu C et al, 2021].…”

Haemostatic support in postpartum haemorrhage

“…PPH is defined as primary if the bleeding occurs before delivery of the placenta and up to 24 h after delivery of the fetus, or secondary if it occurs more than 24 h after delivery 9 . PPH risk factors include antepartum haemorrhage, augmented or induced labour, instrumental or caesarean delivery, chorioamnionitis, foetal macrosomia, polyhydramnios, maternal anaemia, thrombocytopenia or hypofibrinogenaemia, maternal obesity, multifetal gestation, preeclampsia, prolonged labour, placentation abnormalities and older age 18–25 . Hereditary haemostatic disorders and a history of PPH in a previous delivery also increase the risk 20,26,27 .…”

“…9 PPH risk factors include antepartum haemorrhage, augmented or induced labour, instrumental or caesarean delivery, chorioamnionitis, foetal macrosomia, polyhydramnios, maternal anaemia, thrombocytopenia or hypofibrinogenaemia, maternal obesity, multifetal gestation, preeclampsia, prolonged labour, placentation abnormalities and older age. [18][19][20][21][22][23][24][25] Hereditary haemostatic disorders and a history of PPH in a previous delivery also increase the risk. 20,26,27 However, it is estimated that about 40% of PPH cases occur in women who do not have any risk factors, emphasising the importance of surveillance in all women.…”

Predictors of postpartum hemorrhage in vaginal deliveries

“…In developing countries, maternal mortality and morbidity are primarily caused by postpartum hemorrhage (Picetti et al, 2020). Approximately 14 million women worldwide experience bleeding after giving birth each year (Liu et al, 2021). About 529,000 females each year are die due to complications during or after pregnancy, up to 30% of these deaths occur because of postpartum hemorrhage in the developing countries (Ruppel et al, 2021).…”