Risk Factors of Postpartum Hemorrhage in Bondowoso District, East Java

Abstract

Background: Postpartum hemorrhage is the leading cause of the maternal death worldwide. Postpartum hemorrhage accounted 20% of all causes of maternal death in Bondowoso, East Java. This study aimed to examine the risk factors of postpartum hemorrhage. Subjects and Method: This was an analytic observational study using case control design. The study was carried out at 5 community health centers, Bondowoso District, East Java, from March to May 2017. A sample of 120 study subjects were selected for this study by fixed disease sampling, consisting of 40 postpartum women with hemorrhage and 80 postpartum women without hemorrhage. The dependent variable was postpartum hemorrhage. The independent variables were family income, birth space, type of delivery, mother's middle upper arm circumference (MUAC), antenatal visit, and high-risk score card. The data were collected by a set of pre-tested questionnaire. Path analysis was employed for data analysis. Results: Post partum bleeding was directly affected by birth space <2 years or > 10 years (b=3.03; 95% CI = 1.52 to 4.55; p< 0.001), antenatal visit ≥ 4 times (b=3.35; 95% CI= 1.82 to 4.87; p< 0.001), High risk score <2 (b=2.18; 95% CI= 0.92 to 3.44; p= 0.001), type of delivery (b=1.63; 95% CI= 0.39 to 2.87; p= 0.010). High-risk score card was affected by birth space <2 years or > 10 years (b=0.80; 95% CI= 0.32 to 1.57; p= 0.041), family income < Rp 1,417,000 (b=0.72; 95% CI= -0.57 to 1.49; p= 0.070), and antenatal visit ≥ 4 (b=0.70; 95% CI= -0.07 to 1.48; p= 0.076). MUAC was affected by family income ≥ Rp 1,417,000 (b=0.67; 95% CI= -0.08 to 1.44; p= 0.083). Type of delivery (assisted) was affected by high-risk score card <2 (b=1.00; 95% CI = 0.22 to 1.77; p= 0.011) and mother's MUAC <23.5 cm (b=1.04; 95% CI= 0.20 to 1.88; p= 0.015). Conclusion: Post partum bleeding was directly affected by birth space, antenatal visit, high risk score, type of delivery. High-risk score card was affected by birth space, family income, and antenatal visit. MUAC was affected by family income. Type of delivery (assisted) was affected by high-risk score card and mother's MUAC.

Path Analysis on Determinants of Postpartum Bleeding at Dr. Moewardi Hospital, Central Java

“…The condition of the uterus at <2 years of pregnancy was not maximal to provide nutritional reserves for the mother and fetus, so that the mother experienced nutritional disorders and anemia and impaired fetal development. Pregnant women who get anemia would increase the risk of bleeding during labor (Puspitasari et al, 2017).…”

“…Labor action included maternal vaginal actions, namely vacuum, forceps, episiotomy, and oxytocin drip and the palate, cesarean section. Actions in both vaginal and abdominal labor can cause trauma to both the mother and the baby (Puspitasari et al, 2017). 11.…”