Frequency of Occurrence, Main Risk Factors and Effectiveness of Treatment of Patients with Postpartum Hemorrhage

Abstract

Aim: to evaluate the frequency of postpartum hemorrhage (PPH) in a high risk hospital, to conduct a comparative assessment of the clinical, historical and laboratory features of patients with PPH, and the effectiveness of the algorithm of PPH management after vaginal birth (VB) and caesarean section (CS). Design: retrospective study. Material and methods. The study included 15,480 patients. The frequency of early PPH and the effectiveness of applying a local stepwise algorithm for management of PPH were evaluated. Clinical historical and laboratory data were obtained by copying from the primary documentation. Results. The incidence of PPH in a high risk hospital is 0.67%. The most significant risk factor for PPH is the induction of labor, but more than a third of women do not have significant risk factors. The volume of blood loss after CS was 1218.29 ± 728.15 ml, after VB — 784.12 ± 304.44 ml (p<0.001). Uterine balloon tamponade was used in 28 (44.4%) women with PPH after VB and in 27 (65.9%) after CS (χ2 = 4.600; p = 0.142). Compression sutures on the uterus were used in 12 (29.3%) patients after CS and in 3 (2.9%) puerperas after VB (χ2 = 2.8; p = 0.001). Hysterectomy was performed in 4 (9.8%) cases only after CS. Conclusion: The existing algorithms for management PPH are highly effective and allow avoiding hysterectomy in VB in 100% of cases, in CS — in 90.2%. Keywords: postpartum hemorrhage, uterotonics, controlled balloon tamponade, complex compression haemostasis.