Risk Factors for Postpartum Hemorrhage in a Thai-Myanmar Border Community Hospital: A Nested Case-Control Study.

Waraporn Thepampan,Phichayut Phinyo,Nuchsara Eungapithum,Krittai Tanasombatkul

doi:10.3390/ijerph18094633

Abstract

Postpartum hemorrhage (PPH) is a common complication of pregnancy and a global public health concern. Even though PPH risk factors were extensively studied and reported in literature, almost all studies were conducted in non-Asian countries or tertiary care centers. Our study aimed to explore relevant risk factors for PPH among pregnant women who underwent transvaginal delivery at a Thai–Myanmar border community hospital in Northern Thailand. An exploratory nested case-control study was conducted to explore risk factors for PPH. Women who delivered transvaginal births at Maesai hospital from 2014 to 2018 were included. Two PPH definitions were used, which were ≥ 500 mL and 1000 mL of estimated blood loss within 24 h after delivery. Multivariable conditional logistic regression was used to identify significant risk factors for PPH and severe PPH. Of 4774 women with vaginal births, there were 265 (5.55%) PPH cases. Eight factors were identified as independent predictors for PPH and severe PPH: elderly pregnancy, minority groups, nulliparous, previous PPH history, BMI ≥ 35 kg/m2, requiring manual removal of placenta, labor augmentation, and fetal weight > 4000 gm. Apart from clinical factors, particular attention should be given to pregnant women who were minority groups as PPH risk significantly increased in this population.

Highlights

Published: 27 April 2021Postpartum hemorrhage (PPH) is a common complication of pregnancy and a major cause of maternal mortality worldwide [1]
The highest prevalence was usually identified in district hospitals where healthcare resources were limited, and the distribution of risk factors was different from hospitals in the urban area [5,6]
The estimated blood loss was significantly different between postpartum hemorrhage (PPH) cases and non-PPH controls

Summary

Introduction

Postpartum hemorrhage (PPH) is a common complication of pregnancy and a major cause of maternal mortality worldwide [1]. The ACOG reVITALize program defined PPH as a total blood loss of more than or equal to 1000 mL, or any blood loss accompanied by clinical signs and symptoms of hypovolemic shock within 24 h after the birth process. In practice, a blood loss of more than 500 mL should be considered precautious, and early management should be initiated [2,3]. The overall prevalence of PPH in SouthEastern Asia was previously reported at 4.88% [4]. The highest prevalence was usually identified in district hospitals where healthcare resources were limited, and the distribution of risk factors was different from hospitals in the urban area [5,6]

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Conclusion