Postpartum Hemorrhage Resulting From Uterine Atony After Vaginal

8/10/2019 Postpartum Hemorrhage Resulting From Uterine Atony After Vaginal

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Tutor :

Dr. Tigor P. Simanjuntak, SpOG

Presented by :

Corianty Dewi Monica


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Postpartum hemorrhage remains the

leading cause of maternal mortality

worldwide and the main component of

severe maternal morbidity in Western

countries.

Most postpartum hemorrhages are the

result of uterine atony.


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Two categories of explanatory factors can

be considered:

The individual characteristics of women

Deliveries and factors related to medical care


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The aim of this study :

Identify factors associated with postpartum

hemorrhage severity in women with

postpartum hemorrhage resulting from

uterine atony after vaginal delivery.


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The study population : women with

postpartum hemorrhage.

The main objective : to evaluate a

multifaceted educational intervention for

reducing the rate of severe postpartum

hemorrhage.

Data collected : December 2004 - November

2006.


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Postpartum hemorrhage :

The estimated postpartum blood loss >

500 mL or peripartum change in Hb > 2

g/dL (considered equivalent to the loss of

more than 500 mL of blood).

The postpartum Hb level : 3 days after

delivery.


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During the 1-year data

collection period, 9,365cases of postpartum

hemorrhage occurred

among 146,876

deliveries.

Finally, the study

population included

4,550 women.


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Severe postpartum hemorrhage :

Peripartum change in Hb of 4 g/dL or more

(considered equivalent to the loss of 1,000 mL

or more of blood).


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Risk factors for severe postpartum

hemorrhage :

Characteristics of the women and aspects of

labor and delivery before postpartum

hemorrhage.

Components of initial postpartum hemorrhage

management. Organizational characteristics of the units.


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Women and Pregnancy

Age in years at

delivery

Body mass index atconception

Parity and previous

cesarean delivery

History of postpartumhemorrhage

Multiple pregnancy

Hydramnios

Fibroma

Labor

Onset of labor

Epidural analgesia

Prolonged labor

Oxytocin during labor

Prolonged expulsive efforts

Delivery

Gestational age at delivery

Birth weight Delivery

Prophylactic uterotonics


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Oxytocin administration

Manual examination of the uterine cavity

The calls for assistance from a senior

obstetrician and an anesthesiologist


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Status

Level of care

Number of deliveries annually

24-h presence of obstetrician and an

anesthesiologist


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A logistic regression analysis

Separate multilevel models

The association of eachorganizational characteristic


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Among 4,550 women with postpartum

hemorrhage in the study population, 952

(20.9%) had severe postpartum

hemorrhage.


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When we controlled for the characteristics of

women, labor, and delivery, severe

postpartum hemorrhage was not

significantly associated with the annual

number of deliveries, the level of care, or the

on-site presence of an obstetrician or an

anesthesiologist


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Several of these characteristics

previous cesarean delivery

cervical ripening

episiotomy

related to the management of labor and

delivery.

51% had at least 1 of these 3 characteristics Efforts to these procedures may the

incidence of severe postpartum hemorrhage.


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Episiotomy is associated with risk of

severe postpartum hemorrhage

The risk of severe postpartum

hemorrhage in women who received

preventive oxytocin > women with who

had no prophylaxis.


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Epidural anesthesia had a protective effect

Delay in initial postpartum hemorrhage care

was associated with risk of severepostpartum hemorrhage.

The risk of severe blood loss is in public

nonuniversity hospitals compared with other

public university or private hospitals.


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Identifying factors that influence the

course of postpartum hemorrhage has

direct potential implications.

Delayed initial care for postpartum

hemorrhage and place of delivery the

risk of heavy postpartum bleeding caused

by atony.


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Reducing the use cervical ripening,

episiotomy, or cesarean delivery, in particular

situations in which these interventions do not

provide clear benefits as well improving the

rapidity of first care, may reduce the

incidence of severe postpartum hemorrhage.


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Postpartum Hemorrhage Resulting From Uterine Atony After Vaginal