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Severe postpartum hemorrhage from uterine atony: a multicentric study
Carlos Montufar-Rueda1, Laritza Rodriguez2, José Douglas Jarquin3
1Critical Care Obstetrics Unit, Complejo Hospitalario, Caja de Seguro Social, Bella Vista, Panama City, Panama.
Journal of Pregnancy
|December 24, 2013
Summary
Severe postpartum hemorrhage (PPH), often due to uterine atony, requires prompt intravascular volume resuscitation and early blood product transfusion to prevent maternal deaths. This multicenter study evaluated PPH management strategies.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Critical Care Medicine
Background:
- Postpartum hemorrhage (PPH) is a leading global cause of maternal mortality (MM).
- Uterine atony accounts for approximately 70% of PPH cases.
- Effective management of severe PPH is crucial for improving maternal outcomes.
Purpose of the Study:
- To evaluate multicenter cases of severe postpartum hemorrhage (SPHH) over a 10-month period.
- To assess the management strategies employed for SPHH secondary to uterine atony.
Main Methods:
- A prospective, longitudinal, multicenter cohort study involving 13 teaching hospitals.
- Inclusion criteria: vaginal delivery or cesarean section patients with SPHH due to uterine atony.
- Data collected over a 10-month study period.
Main Results:
- 218 cases (0.17%) of SPHH were identified among 124,019 live births.
- The maternal mortality rate was 3.6% (8 deaths), with a maternal mortality rate of 6.45 per 100,000 live births.
- Maternal deaths were linked to inadequate transfusion therapy.
Conclusions:
- Intravascular volume resuscitation is paramount in managing severe hemorrhage and hypovolemic shock to prevent organ damage and death.
- Early transfusion of blood products, including fresh frozen plasma and packed red blood cells, is recommended to prevent maternal deaths in severe or massive hemorrhage.
