Postpartum Hemorrhage: Risk Factors and Preventive Strategies

Gonzalez Carrillo Lissette Alejandra; Rodriguez Zambrano Miguel Angel; Kirk Grohar Janette Lisbeth

doi:doi:10.11648/j.jgo.20210906.13

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Postpartum Hemorrhage: Risk Factors and Preventive Strategies

Gonzalez Carrillo Lissette Alejandra, Rodriguez Zambrano Miguel Angel, Kirk Grohar Janette Lisbeth

Published in Journal of Gynecology and Obstetrics (Volume 9, Issue 6)

Received: 18 October 2021 Accepted: 3 November 2021 Published: 10 November 2021

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Abstract

Background: Postpartum hemorrhage is considered the leading cause of pregnancy related deaths worldwide, with an estimated 140,000 women dying annually from this complication. Aim: Postpartum hemorrhage is defined as the loss of more than 500 ml of blood after delivery or more than 1000 ml of blood after cesarean section. However, there are variations in its definition between societies and clinical practice guidelines. Findings: The incidence of postpartum hemorrhage is generally estimated between 4% and 6% and some studies report that identifiable risk factors can only be found in 39% of patients, so at least 2/3 of the women could have postpartum hemorrhage without any identifiable risk factor. Discussion: Today there is still an upward trend in the incidence of postpartum hemorrhage, some authors believe that it may be due to the change in maternal characteristics or assisted reproductive techniques but there is little evidence to support it, instead it seems that it may be due to a delay in identification and treatment. Conclusion: it is important to take action without delay at the onset of postpartum hemorrhage that includes the implementation of established protocols and patient fluid management, with a trained team in the identification, reducing maternal morbidity and mortality due to this complication.

Published in	Journal of Gynecology and Obstetrics (Volume 9, Issue 6)
DOI	10.11648/j.jgo.20210906.13
Page(s)	200-205
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Postpartum Hemorrhage, Risk Factors, Threatment Protocols, Preventive Strategies, Placenta, Bledding

References

[1]	Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global health. 2014; 2 (6): e323-33.
[2]	Gahres EE, Albert SN, Dodek SM. Intrapartum blood loss measured with Cr 51-tagged erythrocytes. Obstetrics and gynecology. 1962; 19: 455-62.
[3]	American College of O, Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstetrics and gynecology. 2006; 108 (4): 1039-47.
[4]	Dahlke JD, Mendez-Figueroa H, Maggio L, Hauspurg AK, Sperling JD, Chauhan SP, et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. American journal of obstetrics and gynecology. 2015; 213 (1): 76 e1- e10.
[5]	Magann EF, Evans S, Hutchinson M, Collins R, Howard BC, Morrison JC. Postpartum hemorrhage after vaginal birth: an analysis of risk factors. Southern medical journal. 2005; 98 (4): 419-22.
[6]	Combs CA, Murphy EL, Laros RK, Jr. Factors associated with postpartum hemorrhage with vaginal birth. Obstetrics and gynecology. 1991; 77 (1): 69-76.
[7]	Mehrabadi A, Hutcheon JA, Lee L, Liston RM, Joseph KS. Trends in postpartum hemorrhage from 2000 to 2009: a population-based study. BMC pregnancy and childbirth. 2012; 12: 108.
[8]	Mehrabadi A, Liu S, Bartholomew S, Hutcheon JA, Kramer MS, Liston RM, et al. Temporal trends in postpartum hemorrhage and severe postpartum hemorrhage in Canada from 2003 to 2010. Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC. 2014; 36 (1): 21-33.
[9]	Cameron CA, Roberts CL, Olive EC, Ford JB, Fischer WE. Trends in postpartum haemorrhage. Australian and New Zealand journal of public health. 2006; 30 (2): 151-6.
[10]	Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United States, 1994-2006. American journal of obstetrics and gynecology. 2010; 202 (4): 353 e1-6.
[11]	Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best practice & research Clinical obstetrics & gynaecology. 2008; 22 (6): 999-1012.
[12]	Sosa CG, Althabe F, Belizan JM, Buekens P. Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population. Obstetrics and gynecology. 2009; 113 (6): 1313-9.
[13]	Hoveyda F, MacKenzie IZ. Secondary postpartum haemorrhage: incidence, morbidity and current management. BJOG: an international journal of obstetrics and gynaecology. 2001; 108 (9): 927-30.
[14]	Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic Z. Treatment for primary postpartum haemorrhage. The Cochrane database of systematic reviews. 2014 (2): CD003249.
[15]	Wetta LA, Szychowski JM, Seals S, Mancuso MS, Biggio JR, Tita AT. Risk factors for uterine atony/postpartum hemorrhage requiring treatment after vaginal delivery. American journal of obstetrics and gynecology. 2013; 209 (1): 51 e1-6.
[16]	Bonnet MP, Basso O, Bouvier-Colle MH, Dupont C, Rudigoz RC, Fuhrer R, et al. Postpartum haemorrhage in Canada and France: a population-based comparison. PloS one. 2013; 8 (6): e66882.
[17]	Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesthesia and analgesia. 2010; 110 (5): 1368-73.
[18]	Sentilhes L, Goffinet F, Vayssiere C, Deneux-Tharaux C. Comparison of postpartum haemorrhage guidelines: discrepancies underline our lack of knowledge. BJOG: an international journal of obstetrics and gynaecology. 2017; 124 (5): 718-22.
[19]	Kramer MS, Berg C, Abenhaim H, Dahhou M, Rouleau J, Mehrabadi A, et al. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. American journal of obstetrics and gynecology. 2013; 209 (5): 449 e1-7.
[20]	Ford JB, Roberts CL, Bell JC, Algert CS, Morris JM. Postpartum haemorrhage occurrence and recurrence: a population-based study. The Medical journal of Australia. 2007; 187 (7): 391-3.
[21]	Bingham D, Lyndon A, Lagrew D, Main EK. A state-wide obstetric hemorrhage quality improvement initiative. MCN The American journal of maternal child nursing. 2011; 36 (5): 297-304.
[22]	Dilla AJ, Waters JH, Yazer MH. Clinical validation of risk stratification criteria for peripartum hemorrhage. Obstetrics and gynecology. 2013; 122 (1): 120-6.
[23]	Likis FE, Sathe NA, Morgans AK, Hartmann KE, Young JL, Carlson-Bremer D, et al. Management of Postpartum Hemorrhage. AHRQ Comparative Effectiveness Reviews. Rockville (MD) 2015.
[24]	Oyelese Y, Ananth CV. Postpartum hemorrhage: epidemiology, risk factors, and causes. Clinical obstetrics and gynecology. 2010; 53 (1): 147-56.
[25]	Begley CM, Gyte GM, Devane D, McGuire W, Weeks A. Active versus expectant management for women in the third stage of labour. The Cochrane database of systematic reviews. 2015 (3): CD007412.
[26]	Westhoff G, Cotter AM, Tolosa JE. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. The Cochrane database of systematic reviews. 2013 (10): CD001808.
[27]	Gulmezoglu AM, Lumbiganon P, Landoulsi S, Widmer M, Abdel-Aleem H, Festin M, et al. Active management of the third stage of labour with and without controlled cord traction: a randomised, controlled, non-inferiority trial. Lancet. 2012; 379 (9827): 1721-7.
[28]	Deneux-Tharaux C, Sentilhes L, Maillard F, Closset E, Vardon D, Lepercq J, et al. Effect of routine controlled cord traction as part of the active management of the third stage of labour on postpartum haemorrhage: multicentre randomised controlled trial (TRACOR). Bmj. 2013; 346: f1541.
[29]	Leduc D, Senikas V, Lalonde AB, Clinical Practice Obstetrics C. Active management of the third stage of labour: prevention and treatment of postpartum hemorrhage. Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC. 2009; 31 (10): 980-93.
[30]	Sentilhes L, Vayssiere C, Deneux-Tharaux C, Aya AG, Bayoumeu F, Bonnet MP, et al. Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). European journal of obstetrics, gynecology, and reproductive biology. 2016; 198: 12-21.
[31]	Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. Jama. 2007; 297 (11): 1241-52.
[32]	Rabe H, Reynolds G, Diaz-Rossello J. A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants. Neonatology. 2008; 93 (2): 138-44.
[33]	Sentilhes L, Merlot B, Madar H, Sztark F, Brun S, Deneux-Tharaux C. Postpartum haemorrhage: prevention and treatment. Expert review of hematology. 2016; 9 (11): 1043-61.
[34]	Soltani H, Hutchon DR, Poulose TA. Timing of prophylactic uterotonics for the third stage of labour after vaginal birth. The Cochrane database of systematic reviews. 2010 (8): CD006173.
[35]	Liabsuetrakul T, Choobun T, Peeyananjarassri K, Islam QM. Prophylactic use of ergot alkaloids in the third stage of labour. The Cochrane database of systematic reviews. 2018; 6: CD005456.
[36]	Khan M, Balki M, Ahmed I, Farine D, Seaward G, Carvalho JC. Carbetocin at elective Cesarean delivery: a sequential allocation trial to determine the minimum effective dose. Canadian journal of anaesthesia = Journal canadien d'anesthesie. 2014; 61 (3): 242-8.
[37]	Shaylor R, Weiniger CF, Austin N, Tzabazis A, Shander A, Goodnough LT, et al. National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review. Anesthesia and analgesia. 2017; 124 (1): 216-32.
[38]	Cortet M, Deneux-Tharaux C, Dupont C, Colin C, Rudigoz RC, Bouvier-Colle MH, et al. Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial. British journal of anaesthesia. 2012; 108 (6): 984-9.
[39]	Matsunaga S, Takai Y, Nakamura E, Era S, Ono Y, Yamamoto K, et al. The Clinical Efficacy of Fibrinogen Concentrate in Massive Obstetric Haemorrhage with Hypofibrinogenaemia. Scientific reports. 2017; 7: 46749.
[40]	Wikkelso AJ, Edwards HM, Afshari A, Stensballe J, Langhoff-Roos J, Albrechtsen C, et al. Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial. British journal of anaesthesia. 2015; 114 (4): 623-33.
[41]	Higgins N, Patel SK, Toledo P. Postpartum hemorrhage revisited: new challenges and solutions. Current opinion in anaesthesiology. 2019; 32 (3): 278-84.
[42]	Collaborators WT. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017; 389 (10084): 2105-16.
[43]	Murakami M, Kobayashi T, Kubo T, Hata T, Takeda S, Masuzaki H. Experience with recombinant activated factor VII for severe post-partum hemorrhage in Japan, investigated by Perinatology Committee, Japan Society of Obstetrics and Gynecology. The journal of obstetrics and gynaecology research. 2015; 41 (8): 1161-8.
[44]	Levi M, Levy JH, Andersen HF, Truloff D. Safety of recombinant activated factor VII in randomized clinical trials. The New England journal of medicine. 2010; 363 (19): 1791-800.
[45]	Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle MH, Ford JB, et al. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC pregnancy and childbirth. 2009; 9: 55.
[46]	ACOG Practice Bulletin No 156: Obesity in Pregnancy. Obstetrics and gynecology. 2015; 126 (6): e112-26.
[47]	Butwick AJ, Abreo A, Bateman BT, Lee HC, El-Sayed YY, Stephansson O, et al. Effect of Maternal Body Mass Index on Postpartum Hemorrhage. Anesthesiology. 2018; 128 (4): 774-83.
[48]	Sheen JJ, Wright JD, Goffman D, Kern-Goldberger AR, Booker W, Siddiq Z, et al. Maternal age and risk for adverse outcomes. American journal of obstetrics and gynecology. 2018; 219 (4): 390 e1- e15.

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APA Style

Gonzalez Carrillo Lissette Alejandra, Rodriguez Zambrano Miguel Angel, Kirk Grohar Janette Lisbeth. (2021). Postpartum Hemorrhage: Risk Factors and Preventive Strategies. Journal of Gynecology and Obstetrics, 9(6), 200-205. https://doi.org/10.11648/j.jgo.20210906.13

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ACS Style

Gonzalez Carrillo Lissette Alejandra; Rodriguez Zambrano Miguel Angel; Kirk Grohar Janette Lisbeth. Postpartum Hemorrhage: Risk Factors and Preventive Strategies. J. Gynecol. Obstet. 2021, 9(6), 200-205. doi: 10.11648/j.jgo.20210906.13

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AMA Style

Gonzalez Carrillo Lissette Alejandra, Rodriguez Zambrano Miguel Angel, Kirk Grohar Janette Lisbeth. Postpartum Hemorrhage: Risk Factors and Preventive Strategies. J Gynecol Obstet. 2021;9(6):200-205. doi: 10.11648/j.jgo.20210906.13

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@article{10.11648/j.jgo.20210906.13,
  author = {Gonzalez Carrillo Lissette Alejandra and Rodriguez Zambrano Miguel Angel and Kirk Grohar Janette Lisbeth},
  title = {Postpartum Hemorrhage: Risk Factors and Preventive Strategies},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {9},
  number = {6},
  pages = {200-205},
  doi = {10.11648/j.jgo.20210906.13},
  url = {https://doi.org/10.11648/j.jgo.20210906.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20210906.13},
  abstract = {Background: Postpartum hemorrhage is considered the leading cause of pregnancy related deaths worldwide, with an estimated 140,000 women dying annually from this complication. Aim: Postpartum hemorrhage is defined as the loss of more than 500 ml of blood after delivery or more than 1000 ml of blood after cesarean section. However, there are variations in its definition between societies and clinical practice guidelines. Findings: The incidence of postpartum hemorrhage is generally estimated between 4% and 6% and some studies report that identifiable risk factors can only be found in 39% of patients, so at least 2/3 of the women could have postpartum hemorrhage without any identifiable risk factor. Discussion: Today there is still an upward trend in the incidence of postpartum hemorrhage, some authors believe that it may be due to the change in maternal characteristics or assisted reproductive techniques but there is little evidence to support it, instead it seems that it may be due to a delay in identification and treatment. Conclusion: it is important to take action without delay at the onset of postpartum hemorrhage that includes the implementation of established protocols and patient fluid management, with a trained team in the identification, reducing maternal morbidity and mortality due to this complication.},
 year = {2021}
}

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TY  - JOUR
T1  - Postpartum Hemorrhage: Risk Factors and Preventive Strategies
AU  - Gonzalez Carrillo Lissette Alejandra
AU  - Rodriguez Zambrano Miguel Angel
AU  - Kirk Grohar Janette Lisbeth
Y1  - 2021/11/10
PY  - 2021
N1  - https://doi.org/10.11648/j.jgo.20210906.13
DO  - 10.11648/j.jgo.20210906.13
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 200
EP  - 205
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20210906.13
AB  - Background: Postpartum hemorrhage is considered the leading cause of pregnancy related deaths worldwide, with an estimated 140,000 women dying annually from this complication. Aim: Postpartum hemorrhage is defined as the loss of more than 500 ml of blood after delivery or more than 1000 ml of blood after cesarean section. However, there are variations in its definition between societies and clinical practice guidelines. Findings: The incidence of postpartum hemorrhage is generally estimated between 4% and 6% and some studies report that identifiable risk factors can only be found in 39% of patients, so at least 2/3 of the women could have postpartum hemorrhage without any identifiable risk factor. Discussion: Today there is still an upward trend in the incidence of postpartum hemorrhage, some authors believe that it may be due to the change in maternal characteristics or assisted reproductive techniques but there is little evidence to support it, instead it seems that it may be due to a delay in identification and treatment. Conclusion: it is important to take action without delay at the onset of postpartum hemorrhage that includes the implementation of established protocols and patient fluid management, with a trained team in the identification, reducing maternal morbidity and mortality due to this complication.
VL  - 9
IS  - 6
ER  -

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Author Information

Gonzalez Carrillo Lissette Alejandra

Department of Gynecology & Obstetrics at HM Puerta del Sur University Hospital, Madrid, Spain
Rodriguez Zambrano Miguel Angel

Department of Gynecology & Obstetrics at HM Puerta del Sur University Hospital, Madrid, Spain
Kirk Grohar Janette Lisbeth

Department of Gynecology & Obstetrics at HM Puerta del Sur University Hospital, Madrid, Spain

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Plain Text BibTeX RIS

APA Style

Gonzalez Carrillo Lissette Alejandra, Rodriguez Zambrano Miguel Angel, Kirk Grohar Janette Lisbeth. (2021). Postpartum Hemorrhage: Risk Factors and Preventive Strategies. Journal of Gynecology and Obstetrics, 9(6), 200-205. https://doi.org/10.11648/j.jgo.20210906.13

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ACS Style

Gonzalez Carrillo Lissette Alejandra; Rodriguez Zambrano Miguel Angel; Kirk Grohar Janette Lisbeth. Postpartum Hemorrhage: Risk Factors and Preventive Strategies. J. Gynecol. Obstet. 2021, 9(6), 200-205. doi: 10.11648/j.jgo.20210906.13

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AMA Style

Gonzalez Carrillo Lissette Alejandra, Rodriguez Zambrano Miguel Angel, Kirk Grohar Janette Lisbeth. Postpartum Hemorrhage: Risk Factors and Preventive Strategies. J Gynecol Obstet. 2021;9(6):200-205. doi: 10.11648/j.jgo.20210906.13

Copy | Download

@article{10.11648/j.jgo.20210906.13,
  author = {Gonzalez Carrillo Lissette Alejandra and Rodriguez Zambrano Miguel Angel and Kirk Grohar Janette Lisbeth},
  title = {Postpartum Hemorrhage: Risk Factors and Preventive Strategies},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {9},
  number = {6},
  pages = {200-205},
  doi = {10.11648/j.jgo.20210906.13},
  url = {https://doi.org/10.11648/j.jgo.20210906.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20210906.13},
  abstract = {Background: Postpartum hemorrhage is considered the leading cause of pregnancy related deaths worldwide, with an estimated 140,000 women dying annually from this complication. Aim: Postpartum hemorrhage is defined as the loss of more than 500 ml of blood after delivery or more than 1000 ml of blood after cesarean section. However, there are variations in its definition between societies and clinical practice guidelines. Findings: The incidence of postpartum hemorrhage is generally estimated between 4% and 6% and some studies report that identifiable risk factors can only be found in 39% of patients, so at least 2/3 of the women could have postpartum hemorrhage without any identifiable risk factor. Discussion: Today there is still an upward trend in the incidence of postpartum hemorrhage, some authors believe that it may be due to the change in maternal characteristics or assisted reproductive techniques but there is little evidence to support it, instead it seems that it may be due to a delay in identification and treatment. Conclusion: it is important to take action without delay at the onset of postpartum hemorrhage that includes the implementation of established protocols and patient fluid management, with a trained team in the identification, reducing maternal morbidity and mortality due to this complication.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Postpartum Hemorrhage: Risk Factors and Preventive Strategies
AU  - Gonzalez Carrillo Lissette Alejandra
AU  - Rodriguez Zambrano Miguel Angel
AU  - Kirk Grohar Janette Lisbeth
Y1  - 2021/11/10
PY  - 2021
N1  - https://doi.org/10.11648/j.jgo.20210906.13
DO  - 10.11648/j.jgo.20210906.13
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 200
EP  - 205
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20210906.13
AB  - Background: Postpartum hemorrhage is considered the leading cause of pregnancy related deaths worldwide, with an estimated 140,000 women dying annually from this complication. Aim: Postpartum hemorrhage is defined as the loss of more than 500 ml of blood after delivery or more than 1000 ml of blood after cesarean section. However, there are variations in its definition between societies and clinical practice guidelines. Findings: The incidence of postpartum hemorrhage is generally estimated between 4% and 6% and some studies report that identifiable risk factors can only be found in 39% of patients, so at least 2/3 of the women could have postpartum hemorrhage without any identifiable risk factor. Discussion: Today there is still an upward trend in the incidence of postpartum hemorrhage, some authors believe that it may be due to the change in maternal characteristics or assisted reproductive techniques but there is little evidence to support it, instead it seems that it may be due to a delay in identification and treatment. Conclusion: it is important to take action without delay at the onset of postpartum hemorrhage that includes the implementation of established protocols and patient fluid management, with a trained team in the identification, reducing maternal morbidity and mortality due to this complication.
VL  - 9
IS  - 6
ER  -

Copy | Download