Risk factors for uterine atony/postpartum hemorrhage requiring treatment after vaginal delivery

Introduction: The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage.Methods: This is a single center case-control study conducted in Chongqing city in central China from 1st January 2007 to 31st December 2012 for emergency peripartum hysterectomy performed as a treatment of postpartum hemorrhage both in caesarean and vaginal delivery cases. While the study group included emergency peripartum hysterectomy (n=61) due to intractable postpartum hemorrhage, the control group included no hysterectomy (n=333) during the same study period.Results: We found 61 cases recorded for emergency peripartum hysterectomy for intractable postpartum hemorrhage. Incidence of peripartum hysterectomy was 2.2 per 1000 deliveries. Emergency peripartum hysterectomy as treatment of intractable postpartum hemorrhage include the followings: (i) blood loss 1000-2000 ml, crude odd ratio (OR) =18.48 (95% CI 5.1-65.7), adjusted odd ratio (AOR) = 9.1 (95% CI 2.2-37.7); (ii) blood loss >2000 ml, OR = 152 (95% CI 43.7-528.4), AOR = 45.3 (95% CI 11.6-176.9); (iii) previous caesarean section, OR = 5.5 (95% CI 2.9-9.7), AOR = 3.7(95% CI 1.4-9.9); (iv) uterine atony, OR = 11.9 (95% CI 5.8-24.6), AOR = 7.5 (95% CI 1.8-30.2); (v) placenta previa, OR = 2.04 (95% CI 1.1-3.5), AOR = none. Conclusions: Emergency peripartum hysterectomy is the last resort as treatment of intractable severe postpartum hemorrhage. Our study depicts that severe post partum hemorrhage, further dreaded complex events for emergency peripartum hysterectomy, has significant association with placental factors, previous caesarean section, and uterine atony. Pathologically, placenta accreta remained the most leading cause of hysterectomy.Keywords: caesarean section; hemorrhage; peripartum hysterectomy; placenta previa.

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147: Risk factors for uterine atony at vaginal delivery: a comprehensive evaluation

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2010.10.163 ◽

2011 ◽

Vol 204 (1) ◽

pp. S71-S72 ◽

Cited By ~ 4

Author(s):

Luisa Wetta ◽

Jeff Szychowski ◽

Samantha Seals ◽

Melissa Mancuso ◽

John Hauth ◽

...

Keyword(s):

Risk Factors ◽

Vaginal Delivery ◽

Comprehensive Evaluation ◽

Uterine Atony

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Postpartum Hemorrhage Resulting From Uterine Atony After Vaginal Delivery: Factors Associated With Severity

Yearbook of Obstetrics Gynecology and Women s Health ◽

10.1016/j.yobg.2011.06.007 ◽

2011 ◽

Vol 2011 ◽

pp. 73-75

Author(s):

L.P. Shulman

Keyword(s):

Vaginal Delivery ◽

Postpartum Hemorrhage ◽

Uterine Atony ◽

Factors Associated

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Postpartum Hemorrhage Resulting From Uterine Atony After Vaginal Delivery: Factors Associated With Severity

Yearbook of Anesthesiology and Pain Management ◽

10.1016/j.yane.2011.08.014 ◽

2012 ◽

Vol 2012 ◽

pp. 323-324

Author(s):

D.H. Chestnut

Keyword(s):

Vaginal Delivery ◽

Postpartum Hemorrhage ◽

Uterine Atony ◽

Factors Associated

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Cost-effectiveness of Carbetocin versus Oxytocin for Prevention of Postpartum Hemorrhage Resulting from Uterine Atony in Women at high-risk for bleeding in Colombia

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0038-1655747 ◽

2018 ◽

Vol 40 (05) ◽

pp. 242-250 ◽

Cited By ~ 2

Author(s):

Yaneth Gil-Rojas ◽

Pieralessandro Lasalvia ◽

Fabián Hernández ◽

Camilo Castañeda-Cardona ◽

Diego Rosselli

Keyword(s):

Cost Effectiveness ◽

Cesarean Section ◽

Vaginal Delivery ◽

Postpartum Hemorrhage ◽

Average Cost ◽

Cost Of Care ◽

Uterine Atony ◽

Hemorrhagic Event ◽

Life Years ◽

The Cost

Objective To assess the cost-effectiveness of carbetocin versus oxytocin for prevention of postpartum hemorrhage (PPH) due to uterine atony after vaginal delivery/cesarean section in women with risk factors for bleeding. Methods A decision tree was developed for vaginal delivery and another one for cesarean, in which a sequential analysis of the results was obtained with the use of carbetocin and oxytocin for prevention of PPH and related consequences. A third-party payer perspective was used; only direct medical costs were considered. Incremental costs and effectiveness in terms of quality-adjusted life years (QALYs) were evaluated for a one-year time horizon. The costs were expressed in 2016 Colombian pesos (1 USD = 3,051 Col$). Results In the vaginal delivery model, the average cost of care for a patient receiving prophylaxis with uterotonic agents was Col$ 347,750 with carbetocin and Col$ 262,491 with oxytocin, while the QALYs were 0.9980 and 0.9979, respectively. The incremental cost-effectiveness ratio is above the cost-effectiveness threshold adopted by Colombia. In the model developed for cesarean section, the average cost of a patient receiving prophylaxis with uterotonics was Col$ 461,750 with carbetocin, and Col$ 481,866 with oxytocin, and the QALYs were 0.9959 and 0.9926, respectively. Carbetocin has lower cost and is more effective, with a saving of Col$ 94,887 per avoided hemorrhagic event. Conclusion In case of elective cesarean delivery, carbetocin is a dominant alternative in the prevention of PPH compared with oxytocin; however, it presents higher costs than oxytocin, with similar effectiveness, in cases of vaginal delivery.

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Prevalence and Risk Factors Associated With Preeclampsia, Low Birth Weight and Postpartum Hemorrhage in Northern Ghana

10.21203/rs.3.rs-109200/v1 ◽

2020 ◽

Author(s):

Benjamin Ahenkorah ◽

Samuel Sakyi ◽

Gideon Helegbe ◽

Eddie Owiredu ◽

Winfred Ofosu ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Birth Weight ◽

Vaginal Delivery ◽

Postpartum Hemorrhage ◽

Maternal Age ◽

Independent Risk Factor ◽

Male Gender ◽

Northern Ghana ◽

Maternal Complications

Abstract Background: The study evaluated the risks for developing low birth weight (LBW), preeclampsia (PE) and postpartum hemorrhage (PPH) in relation to maternal socio-demographic, obstetric characteristics and clinical laboratory information obtained at 1st antenatal care (ANC) visit.Methods: The study included 268 pregnant women attending 1st ANC visit at the Bolgatanga Regional Hospital. Structured questionnaires were used to obtain socio-demographic and obstetric data from respondents. The main variables were LBW, PPH, PE, mode of delivery, residency, gestational age at 1st ANC visit, maternal age, sickling positivity, Hb at 1st ANC visit, Hb genotype and G6PD status. Odds ratio [OR, 95% confidence interval (CI)] for the association between sociodemographic, obstetric characteristics and clinical variables in relation to PE, LBW and PPH were assessed using logistic regression model.Results: The prevalence of PE, LBW and PPH were 25.4% (68/268), 15.7% (42/268) and 6.0% (16/268), respectively. For PE, delayed 1st ANC visit (AOR=16.82, 95% CI (3.61-78.5), p=0.000) and younger maternal age (AOR= 15.19, 95% CI (1.85-124.56), p=0.011) were independently associated with higher odds whereas vaginal delivery (AOR=0.32, 95% CI (0.15-0.71), p=0.015) was independently associated with reduced odds. Delayed 1st ANC visit (AOR=0.12, 95% CI (0.03-0.47)), p=0.002) independently reduced the risk of PPH whereas the male gender (AOR=7.75, 95% CI (1.60-37.51), p=0.011) independently increased the risk of PPH. Lastly, delayed 1st ANC visit (AOR=3.26, 95% CI (1.05-10.10), p=0.041) was independently associated with increased odds of LBW whereas vaginal delivery (AOR=0.36, 95% CI (0.17-0.74), p=0.006) was an independent risk factor for LBW in the multivariate model.Conclusion: The study identified delayed ANC visit as an independent risk factor for PE, LBW and PPH in Northern Ghana. Vaginal delivery and younger maternal age were also independent risk factors for PE. Additionally, the male gender was independently associated with PPH whereas vaginal delivery was independently associated with LBW. We recommend that public health education for pregnant women that highlights the importance of early ANC visit be enhanced. This will facilitate early identification and intervention for women with risk of foeto-maternal complications. Younger women should be educated on the dangers 48 of early marriages with its attendant foeto-maternal complications.

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Postpartum Hemorrhage Resulting From Uterine Atony After Vaginal Delivery

Obstetrics and Gynecology ◽

10.1097/aog.0b013e318202c845 ◽

2011 ◽

Vol 117 (1) ◽

pp. 21-31 ◽

Cited By ~ 101

Author(s):

Marine Driessen ◽

Marie-Hèlène Bouvier-Colle ◽

Corinne Dupont ◽

Babak Khoshnood ◽

Renè-Charles Rudigoz ◽

...

Keyword(s):

Vaginal Delivery ◽

Postpartum Hemorrhage ◽

Uterine Atony

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POSTPARTUM HAEMORRHAGE

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.04.2647 ◽

2011 ◽

Vol 18 (04) ◽

pp. 604-610

Author(s):

TEHNIYAT ISHAQ ◽

SAID AMIN ◽

ISHAQ KHATTAK

Keyword(s):

Risk Factors ◽

Maternal Mortality ◽

Postpartum Hemorrhage ◽

Past History ◽

Mode Of Delivery ◽

Cross Sectional Study ◽

Uterine Atony ◽

Cross Sectional ◽

High Dependency ◽

History Of

Objective: To determine the frequency, risk factors and existing practice for the management of massive primary postpartum hemorrhage (PPH). Study design: Retrospective cross-sectional study. Setting: Department of Obstetrics & Gynaecology at Kuwait Teaching Hospital, Peshawar. Materials and methods: this study was performed from June 2008 to June 2010. Women who developed massive primary PPH after admission or were admitted with it, were included in the study. Medical record files of these women were reviewed for maternal mortality and morbidities which included mode of delivery, possible cause of postpartum hemorrhage, supportive medical and surgical intervention. Data was entered in the pre-structured proforma. Estimates of blood loss were made on history, visual parameters and patient’s condition. All the data was analyzed by using statistical computer soft ware SPSS 6. Results: During the study period total number of obstetrical admissions were 2944. Forty nine out of 2769 (1.76%) deliveries, developed massive primary PPH. The highest frequency of massive primary PPH was observed in grand multiparous patients. Uterine atony was the most common cause of the complication. Birth attendants other than doctor and delivery outside the study unit were significantly associated with the adverse outcome in these patients. Seventy five percent patients,(36/49) who had massive PPH, delivered vaginally. High dependency unit (HDU) was required in 12% (6/49) of women. Only one caesarian hysterectomy was done. There was one maternal mortality. Blood transfusions were required in 82% (40/49) of the patients. Conclusions: Postpartum hemorrhage can be a preventable condition if early identification and timely management of this complication and its risk factors is observed. Uterine atony is the leading cause of immediate PPH. The main risk factors for PPH due to uterine atony are high parity, a large fetus, multiple fetuses, hydramnios, or past history of PPH. Determining the frequency, risk factors and management of primary postpartum hemorrhage will help design stepwise protocols for prevention and management of primary PPH in our setup.

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