Analysis Of The Clinical Characteristics Of Severe Postpartum Hemorrhage

Severe postpartum hemorrhage remains a major cause of maternal morbidity and mortality in the world. Peripartum hysterectomy is performed as a life-saving operation that is performed for severe obstetric hemorrhage that is unresponsive to conservative methods.Although hysterectomy is the most effective process to control obstetric hemorrhage,most women undergoing obstetric hysterectomy were child-bearing period patients, hysterectomy may impact the life quality of these women more or less after operation. Re-exploration for internal bleeding after hysterectomy is a serious clinical condition;ALI is readily develop into adult respiratory distress syndrome(ARDS) and multiple organ dysfunction syndrome(MODS),which results in death finally. Currently, the studies about re-exploration after peripartum hysterectomy and ALI/ARDS for severe postpartum hemorrhage are rarely reported.The purpose of this study was to review of all cases of severe postpartum hemorrhage in Obstetric Critical Care Center of Guangzhou from January 1999 to December 2010 to assess the associated high risk factors of hysterectomy and re-exploration after peripartum hysterectomy and ALI/ARDS that were associated with improving outcomes of patients. ChapterⅠAnalysis of the clinical details of severe postpartum hemorrhageObjectiveOur study was to analyse the causes,complications and outcomes of severe postpartum hemorrhage .Material and methodsWe retrospectively reviewed 316 severe postpartum hemorrhage cases in Obstetric Critical Care Center of Guangzhou from January 1999 to December 2010. Main demographic data and clinical details including age, gravidity, parity, gestationa age, the cause of hemorrhage,the measures of treatment and outcomes. The statistical analyses were conducted with the"SPSS 13.0 for windows"package program. The measurement data of normal distribution were used independent sample t- test and were defined as mean±standard deviation.Frequency and rate were compared with the Chi-square test; P<0.05 was considered statistically significant.Results1. The incidence of severe postpartum hemorrhage is 0.18% in our hospital during the past 11 years. The incidence of severe postpartum hemorrhage of cesarean sections was higher than the incidence of vaginal deliveries (46/15609vs17/ 19014, P=0.001).2. The causes of severe postpartum hemorrhage include coagulopathy (38%,120/ 316) ,uterine atony(29.7%),abnormalities of placentation (21.8%)and genital tract laceration(15.5%).3. The treatments, main complications and outcomes of severe postpartum hemorrhage include conservative surgical procedure(92cases),hemorrhagic shock(206cases),hysterectomy(142cases),DIC(120cases),ALI/ARDS(81cases), maternal death(23cases). Conclusions1. The incidence of severe postpartum hemorrhage is 0.18%.The incidence of severe postpartum hemorrhage of cesarean sections was higher than the incidence of vaginal deliveries.2. Coagulopathy is the leading cause of severe postpartum hemorrhage.ChapterⅡRisk factors associated with peripartum hysterectomy and re-exploration after hysterectomySectionⅠRisk factors associated with peripartum hysterectomy ObjectiveOur study was to estimate the incidence and risk factors associated with peripartum hysterectomy for severe postpartum hemorrhage.Material and methodsWe retrospectively reviewed 142 peripartum hysterectomy cases in Obstetric Critical Care Center of Guangzhou from January 1999 to December 2010. Main demographic data and clinical details including age, gravidity, parity, prenatal care, number of abortion, pathological pregnancy, mode of delivery, method of hysterectomy, the measures of treatment . The statistical analyses were conducted with the"SPSS 13.0 for windows"package program. The measurement data of normal distribution were used independent sample t- test for comparing the differences between hysterectomy and control groups and were defined as mean±standard deviation. Frequency and rate were compared with the Chi-square test.The correlative factors were analyzed by binary logistic regression. P<0.05 was considered statistically significant. Results1. The incidence of peripartum hysterectomy is 0.14% (47/34623) in our hospital during the past 11 years.2. Single factor analysis showed that age≥35years, gravidity, parity, prenatal care,placenta increta or accreta, tissue residue, amniotic fluid embolism,uterine rupture,DIC and conservative surgical procedure were significantly increased in the hysterectomy group(p=0.000,0.007,0.001,0.000,0.001,0.014, 0.000,0.000, 0.000 and 0.000,respectively) as compared with the control group.3. Binary logistic regression analysis showed that age age≥35years ( OR 2.560,95%CI 1.187-5.521), uterine rupture(OR 11.367,95%CI 2.903-44.513), amniotic fluid embolism ( OR 8.808,95%CI 1.859-41.722 ) ,DIC ( OR 5.054,95%CI 2.725-9.367) and placenta increta or accreta(OR 6.805,95%CI 2.998-15.444) were the main risk factors of peripartum hysterectomy. Conservative surgical procedure OR 0.311,95%CI 0.155-0.622) and prenatal care (OR 0.013,95%CI 0.237-0.845)were protect factors.4. The following are risk factors causing peripartum hysterectomy in the order : uterine rupture(OR 13.400,95%CI 3.423-52.455), placenta increta or accreta(OR 7.337,95%CI 3.273-16.448), amniotic fluid embolism(OR 6.711,95%CI 1.620-27.800),DIC(OR 5.178,95%CI 2.804-9.560), age≥35years(OR 2.916,95%CI 1.412-6.021).SectionⅡRisk factors associated with re-exploration after peripartum hysterectomyObjectiveOur study was to estimate the risk factors associated with re-exploration after peripartum hysterectomy for severe postpartum hemorrhage.Material and methodsThe clinical data of 142 obstetric patients who underwent peripartum hysterectomy for severe postpartum hemorrhage in Obstetric Critical Care Center of Guangzhou from January 1999 to December 2010 were retrospectively analyzed. Among them, 18 cases underwent re-exploration after peripartum hysterectomy.Main demographic data and clinical details including age, gravidity, parity, prenatal care, pathological pregnancy, time and method of hysterectomy, hosptial of hysterectomy, blood loss ,the measures of treatment . The statistical analyses were conducted with the"SPSS 13.0 for windows"package program. The measurement data of normal distribution were used independent sample t- test for comparing the differences between re-exploration and control groups and were defined as mean±standard deviation. Frequency and rate were compared with the Chi-square test.The correlative factors were analyzed by binary logistic regression. P<0.05 was considered statistically significant.Results1. The incidence of re-exploration after peripartum hysterectomy is 12.7% (18/142).2. Single factor analysis showed that prenatal care, amniotic fluid embolism,DIC, hosptial of hysterectomy,blood loss , time of hysterectomy and blood transfusion were significantly increased in the re-exploration group (p=0.047,0.015,0.003,0.034,0.000,0.041and 0.000, respectively) as compared with the control group.3. Binary logistic regression analysis showed that blood transfusion(OR 1.001,95%CI 1.000-1.001) and blood loss(OR 1.000,95%CI 1.000-1.000) were the main risk factors of re-exploration after peripartum hysterectomy.4. The following are risk factors causing re-exploration after peripartum hysterectomy in the order : blood transfusion(OR 1.000,95%CI 1.000-1.001) as same as blood loss(OR 1.000,95%CI 1.000-1.001).Conclusions1. Uterine rupture, placenta increta or accreta, age≥35years,DIC, amniotic fluid embolism were the main risk factors of peripartum hysterectomy. conservative surgical procedure and prenatal care were protect factors. 2. Blood transfusion and blood loss were the main risk factors of re-exploration after peripartum hysterectomy.ChapterⅢRisk Factors Associated with ALI/ARDS ObjectiveOur study was to estimate the risk factors associated with ALI/ARDS for severe postpartum hemorrhage,and to provide a learn to prevent and treat ALI/ARDS for severe postpartum hemorrhage.Material and methodsThe clinical data of 316 obstetric patients who underwent severe postpartum hemorrhage in Obstetric Critical Care Center of Guangzhou from January 1999 to December 2010 were retrospectively analyzed. Among them, 81 cases underwent ALI/ARDS.Main demographic data and clinical details including age, gravidity, parity, pathological pregnancy, blood loss , blood transfusion,the measures of treatment.The statistical analyses were conducted with the"SPSS 13.0 for windows"package program. The measurement data of normal distribution were used independent sample t- test for comparing the differences between ALI/ARDS and control groups and were defined as mean±standard deviation. Frequency and rate were compared with the Chi-square test.The correlative factors were analyzed by binary logistic regression. P<0.05 was considered statistically significant.Results1. The incidence of ALI/ARDS for severe postpartum hemorrhage is 25.6% (81/316).2. Single factor analysis showed that prenatal care, amniotic fluid embolism, uterine rupture ,DIC, hemorrhagic shock , blood loss, hysterectomy, re-exploration after peripartum hysterectomy,blood transfusion,packed red blood cells transfusion,plasma transfusion,platelet transfusion and cryoprecipitate transfusion were significantly increased in the ALI/ARDS group (p=0.014,0.000,0.042,0.000,0.000, 0.000, 0.000, 0.000,0.000, 0.000,0.000,0.005 and 0.000, respectively) as compared with the control group.3. Binary logistic regression analysis showed that hysterectomy ( OR 12.988,95%CI3.961-42.581) and re-exploration after peripartum hysterectomy(OR 25.547,95%CI 1.843-354.210) were the main risk factors of ALI/ARDS for severe postpartum hemorrhage.4. The following are risk factors causing ALI/ARDS in the order : re-exploration after peripartum hysterectomy(OR 21.266,95%CI7.643-59.169), hysterectomy(OR 1.000,95%CI1.000-1.000).ConclusionRe-exploration after peripartum hysterectomy, hysterectomy were the main risk factors of ALI/ARDS for severe postpartum hemorrhage.