Analysis Of Related Factors And Treatment Of Severe Postpartum Hemorrhage

ObjectiveTo analyze the risk factors of severe postpartum hemorrhage and outcomes of different clinical interventions,and provide evidence-based basis for early warning,early identification,reduce hysterectomy and maternal mortality rate in high-risk pregnant women.MethodsA retrospective analysis was conducted on 4558 maternal data from July 2015 to December 2017 in the First Affiliated Hospital of Guangzhou Medical University.There were 157 cases of postpartum hemorrhage,including 39 cases of severe postpartum hemorrhage,which were included in the case group(group A),118 cases of non-severe postpartum hemorrhage were included in the control group(group B).Clinical data of 157 cases of postpartum hemorrhage were analyzed retrospectively,including: maternal age,gestational weeks,number of abortion,number of deliveries,numbers of caesarean section deliveries,prenatal d-dimer levels and fibrinogen levels,delivery mode,fetal weight,pregnancy complications,causes of postpartum hemorrhage and its related obstetrical factors.The measurement data were analyzed by independent sample t-test and were expressed as mean±standard deviation.Frequency and rate were compared with the Chi-square test or Fisher exact probability method,P<0.05 was considered statistically significant.The above factors were selected by single factor analysis,statistically significant factors were included in the binary logistic regression model to identify the independent risk factors for severe postpartum hemorrhage.The bleeding volume,blood transfusion volume,hemorrhagic shock,DIC,hysterectomy,and other complications in the group A who underwent different interventions for different bleeding causes were statistically analyzed to determine the effect of different clinical interventions on pregnancy outcomes.Results1.There were statistically significant differences in the number of deliveries,uterus with scar,pregnancy associated with hysteromyoma,placenta previa,and prenatal fibrinogen level among the 12 factors in the case group and the control group.There were no statistically significant differences in maternal age,number of abortions ≥2,hypertensive disorder complicating pregnancy,assisted reproductive technology,prenatal d-dimer level,vagina surgical deliveryand macrosomia.2.There were statistically significant differences in placenta accreta and placenta increta among the obstetric factors related to the causes of hemorrhage in the case group and the control group,P<0.05.There is no statistically significant differences in coagulopathy.3.In the singel factor analysis of the case group and the control group,the above 7 factors were statistically significant.These 7 factors were included in the binary logistic regression model.Finally,prenatal fibrinogen levels and pregnancy associated with hysteromyoma entered the model with fibrinogen levels(OR = 0.413,95% CI 0.201-0.851)and pregnancy associated with hysteromyoma(OR = 15.81,95% CI 1.096-228.109).).4.The rate of uterine tamponade,hysterectomy,and blood transfusion were significantly higher in the case group than in the control group.About 78% cases in the control group got successful hemostasis with conservative treatments such as uterine massage,oxytocin,and carboprost tromethamine.5.A comparison of 11 related factors of hysterectomy in the case group was performed.There were statistically significant differences in placenta increta,coagulopathy and amount of postpartum bleeding within 24 hours,P<0.05.There were no statistically significant differences in placenta previa,pernicious placenta previa,placenta accreta,uterine atony,amniotic fluid embolism,history of postpartum haemorrhage,history of placenta increta and hysteromyoma associated with pregnancy.Conclusions1.Low prenatal fibrinogen levels and hysteromyoma associated with pregnancy are independent risk factors for severe postpartum hemorrhage and can be used as predictors of severe postpartum hemorrhage.2.,Placenta accreta,coagulopathy and amount of postpartum bleeding are risk factors for hysterectomy.Reducing cesarean rate,assessing amount of postpartum bleeding accurately,early identification of severe coagulopathy such as DIC,timely supplementation of coagulation factors can reduce adverse events of hysterectomy,improve maternal outcomes.