postpartum hemorrhage resulting from uterine atony after vaginal
TRANSCRIPT
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Tutor :
Dr. Tigor P. Simanjuntak, SpOG
Presented by :
Corianty Dewi Monica
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Postpartum hemorrhage remains the
leading cause of maternal mortality
worldwide and the main component of
severe maternal morbidity in Western
countries.
Most postpartum hemorrhages are the
result of uterine atony.
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Two categories of explanatory factors can
be considered:
The individual characteristics of women
Deliveries and factors related to medical care
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The aim of this study :
Identify factors associated with postpartum
hemorrhage severity in women with
postpartum hemorrhage resulting from
uterine atony after vaginal delivery.
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The study population : women with
postpartum hemorrhage.
The main objective : to evaluate a
multifaceted educational intervention for
reducing the rate of severe postpartum
hemorrhage.
Data collected : December 2004 - November
2006.
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Postpartum hemorrhage :
The estimated postpartum blood loss >
500 mL or peripartum change in Hb > 2
g/dL (considered equivalent to the loss of
more than 500 mL of blood).
The postpartum Hb level : 3 days after
delivery.
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During the 1-year data
collection period, 9,365cases of postpartum
hemorrhage occurred
among 146,876
deliveries.
Finally, the study
population included
4,550 women.
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Severe postpartum hemorrhage :
Peripartum change in Hb of 4 g/dL or more
(considered equivalent to the loss of 1,000 mL
or more of blood).
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Risk factors for severe postpartum
hemorrhage :
Characteristics of the women and aspects of
labor and delivery before postpartum
hemorrhage.
Components of initial postpartum hemorrhage
management. Organizational characteristics of the units.
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Women and Pregnancy
Age in years at
delivery
Body mass index atconception
Parity and previous
cesarean delivery
History of postpartumhemorrhage
Multiple pregnancy
Hydramnios
Fibroma
Labor
Onset of labor
Epidural analgesia
Prolonged labor
Oxytocin during labor
Prolonged expulsive efforts
Delivery
Gestational age at delivery
Birth weight Delivery
Prophylactic uterotonics
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Oxytocin administration
Manual examination of the uterine cavity
The calls for assistance from a senior
obstetrician and an anesthesiologist
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Status
Level of care
Number of deliveries annually
24-h presence of obstetrician and an
anesthesiologist
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A logistic regression analysis
Separate multilevel models
The association of eachorganizational characteristic
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Among 4,550 women with postpartum
hemorrhage in the study population, 952
(20.9%) had severe postpartum
hemorrhage.
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When we controlled for the characteristics of
women, labor, and delivery, severe
postpartum hemorrhage was not
significantly associated with the annual
number of deliveries, the level of care, or the
on-site presence of an obstetrician or an
anesthesiologist
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Several of these characteristics
previous cesarean delivery
cervical ripening
episiotomy
related to the management of labor and
delivery.
51% had at least 1 of these 3 characteristics Efforts to these procedures may the
incidence of severe postpartum hemorrhage.
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Episiotomy is associated with risk of
severe postpartum hemorrhage
The risk of severe postpartum
hemorrhage in women who received
preventive oxytocin > women with who
had no prophylaxis.
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Epidural anesthesia had a protective effect
Delay in initial postpartum hemorrhage care
was associated with risk of severepostpartum hemorrhage.
The risk of severe blood loss is in public
nonuniversity hospitals compared with other
public university or private hospitals.
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Identifying factors that influence the
course of postpartum hemorrhage has
direct potential implications.
Delayed initial care for postpartum
hemorrhage and place of delivery the
risk of heavy postpartum bleeding caused
by atony.
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Reducing the use cervical ripening,
episiotomy, or cesarean delivery, in particular
situations in which these interventions do not
provide clear benefits as well improving the
rapidity of first care, may reduce the
incidence of severe postpartum hemorrhage.
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