Risk Factors for Postpartum Hemorrhage and its Severe Forms with Blood Loss Evaluated Objectively – A Prospective Cohort Study

Abstract

Objective To identify risk factors related to postpartum hemorrhage (PPH) and severe PPH with blood loss quantified objectively.

Methods This is a complementary analysis of a prospective cohort study that included pregnant women delivering vaginally. The total blood loss was obtained through the sum of the volume collected from the drape with the weight of gauzes, compresses and pads used by women within 2 hours. Exploratory data analysis was performed to assess mean, standard deviation (SD), frequency, percentage and percentiles. The risk factors for postpartum bleeding were evaluated using linear and logistic regression.

Results We included 270 women. The mean blood loss at 120 minutes was 427.49 mL (±335.57 mL). Thirty-one percent (84 women) bled > 500 mL and 8.2% (22 women) bled > 1,000 mL within 2 hours. Episiotomy, longer second stage of labor and forceps delivery were related to blood loss > 500 mL within 2 hours, in the univariate analysis. In the multivariate analysis, only forceps remained associated with bleeding > 500 mL within 2 hours (odds ratio [OR] = 9.5 [2.85–31.53]). Previous anemia and episiotomy were also related to blood loss > 1,000mL.

Conclusion Prolonged second stage of labor, forceps and episiotomy are related to increased incidence of PPH, and should be used as an alert for the delivery assistants for early recognition and prompt treatment for PPH.

Resumo

Objetivo Identificar os fatores de risco para hemorragia pós-parto e hemorragia pós-parto grave com o sangramento pós-parto avaliado objetivamente.

Métodos Trata-se de uma análise complementar de um estudo de coorte prospectivo que incluiu somente mulheres que evoluíram para parto vaginal. O total de perda sanguínea foi avaliado objetivamente durante 24 horas pós-parto através da soma da quantidade de sangue mensurada através de um coletor de sangue pós-parto somado ao peso de compressas, gases e absorventes utilizados no período pós-parto. Análises exploratórias dos dados foram realizadas através do cálculo de médias, desvio-padrão (DP), frequência, porcentagem e percentis. Os fatores de risco foram avaliados através de regressão linear e logística.

Resultados Foram incluídas 270 mulheres. A média de perda sanguínea pós-parto após 120 minutos foi de 427.49 mL (±335.57 mL). Trinta e um por cento (84 mulheres) sangraram > 500 mL e 8,2% (22 mulheres) sangraram > 1.000 mL em 2 horas. Episiotomia, segundo período do parto prolongado e uso de fórceps estiveram associados a perda sanguínea > 500 mL em 2 horas. Na análise multivariada, somente fórceps manteve-se entre os fatores de risco para sangramentos superiores a 500 mL em 2 horas (odds ratio [OR] = 9.5 [2.85–31.53]). Anemia prévia e episiotomia estiveram associadas com perda sanguínea > 1.000 mL.

Conclusão Segundo período do parto prolongado, fórceps e episiotomia estão associados a aumento da incidência de hemorragia pós-parto e devem ser usados como um alerta para os profissionais de saúde para o reconhecimento precoce e tratamento imediato da patologia.

Keywords

risk factors - postpartum hemorrhage - maternal mortality

Palavras-chave

fatores de risco - hemorragia pós-parto - mortalidade materna

Contributions

Borovac-Pinheiro A. and Pacagnella R. C. conceived and designed the study. Borovac-Pinheiro A. and Ribeiro F. M. collected the data. All authors were involved in data analysis, interpretation, and writing. Borovac-Pinheiro A. wrote the first version and all authors approved the final version of the manuscript.

Publication History

Received: 28 January 2020

Accepted: 03 August 2020

Article published online:
28 January 2021

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