Postpartum Hemorrhage Research Paper

The Dangers of Postpartum Hemorrhage

Abstract
This paper discusses the risks associated with postpartum hemorrhaging. Postpartum hemorrhage is an issue that currently accounts for approximately 25-35% of maternal deaths worldwide (Altenstadt, Hukkelhoven, Roosmalen, & Bloemenkamp, 2013). Recent research has indicated that uterine atony is the leading cause of postpartum hemorrhage. Postpartum hemorrhage can result in severe maternal morbidity such as hysterectomy, hypovolemic shock, disseminated intravascular coagulation, and Sheehan’s syndrome. Ongoing research is being conducted in hopes of preventing the occurrence of postpartum hemorrhage and providing more efficient ways to treat the issue that so many women
are faced with.

Postpartum hemorrhage (PPH) is one of the leading causes of both maternal morbidity and mortality worldwide. An estimated 14 million cases of PPH occur worldwide each year with a case-fatality rate of 1%; in a greater perspective, that means that approximately one woman will die every four minutes from postpartum hemorrhage. The risk of death due to postpartum hemorrhage is significantly lower in high-income countries at an estimated rate of 1:100,000 deliveries as compared to low-income countries whose estimated rate of death related to PPH is 1:1,000. Studies on maternal deaths have revealed that most deaths related to postpartum hemorrhage resulted from delayed and substandard care in the diagnosis and management of blood loss. Even with precautions taken and precise management, PPH will affect approximately 3% of vaginal deliveries (Rath, 2011).
Postpartum hemorrhage is divided into two categories, primary and secondary hemorrhaging.
Primary hemorrhage is defined as blood loss that is greater than or equal to 500 milliliters due to a vaginal delivery or 1500 milliliters due to a cesarean section within the first 24 hours following a delivery. Secondary hemorrhaging is defined as excessive vaginal blood loss or heavy lochial discharge, occurring at least 24 hours after the end of the third stage of labor. Uterine atony is found to be the leading cause of PPH, complicating an estimated 5% of deliveries. Other complications that have been thought to result in PPH include vaginal hematoma, a cervical or vaginal tear, adherent placenta, uterine angle extension, and a retained placenta (Edhi, Aslam, Naqvi, Hashmi, 2013).
Approximately 20 million women suffer from an acute or chronic disability following immediate PPH each year, worldwide (Rath, 2011). Research studies have found that postpartum hemorrhage can result in severe maternal morbidity such as hysterectomy, hypovolemic shock, disseminated intravascular coagulation, Sheehan’s syndrome, hepatic dysfunction, acute respiratory distress syndrome, renal failure, and myocardial ischemia. Postpartum hemorrhage has been discovered to also result in long-term morbidity such as anemia, which can result in severe, life threatening
consequences.
Several experiments have been conducted in hopes of linking certain risk factors to postpartum hemorrhage. Researchers are hoping to identify more and more factors that place women at risk, in hopes of reducing the incidence of postpartum hemorrhage and reducing both the mortality and morbidity rate of pregnancies.
Researchers in New Zealand conducted a study to determine if overweight or obese women were at a greater risk of suffering from postpartum hemorrhage following a vaginal or caesarean birth. The research observations were made from 2006 to 2009 with an observation pool that consisted of nulliparous singleton pregnancies that were delivered at term. Researchers discovered that women who were obese were at twice the risk of developing postpartum hemorrhage than those who had a normal range BMI, regardless of the route of delivery. Researchers also discovered through their observations that Pacific Islanders and those of Asian ethnicity were at an increased risk for postpartum hemorrhage.
Searching for a link between pre-eclampsia and postpartum hemorrhage, researchers gathered information from the Netherlands Perinatal Registry dating from the years 2000 to 2008 to conduct their research. Of the women observed, 4.3% developed postpartum hemorrhage and 2.2% of those women experienced complications due to pre-eclampsia previously during the pregnancy. Researchers concluded from their observations that women who experienced issues due to pre-eclampsia were at a 1.53 fold increased risk for developing postpartum hemorrhaging complications (Altenstadt, Hukkelhoven, Roosmalen, Bloemenkamp, 2013).
Recently, research has been conducted to find the most effective treatment for postpartum hemorrhaging, one particularly interesting method intrigued researchers from the Republic of Korea to conduct further studies. The most common treatment related to the management of postpartum hemorrhaging involves the use of uterine stimulants such as oxytocin, prostaglandins, and misoprostol; bimanual compression of the uterus is also a popular intervention in the management of PPH. Debate over the effectiveness of uterine artery embolization (UAE) to treat PPH inspired researchers to perform their own investigations on the argument. After careful examination of records obtained from the Soonchunhyang University Bucheon Hospital, researchers were astounded to find that the UAE procedure produced a 96% success rate with few patients experiencing complications (Kim, et al., 2013).
Postpartum hemorrhaging is a significant issue that many pregnant women are faced against. Although numbers seem to be decreasing over time, PPH still remains one of the leading causes of maternal morbidity and mortality in the world. Both women at risk and healthcare providers should be conscious of the risk factors related to PPH and women should be properly educated on signs and symptoms related to PPH, so that they may prepare to take action if needed.

References
Edhi, M., Aslam, H., Naqvi, Z., & Hashmi, H. (2013). Post partum hemorrhage: causes and management. BMC Research Notes, 6(1), 1-6. doi:10.1186/1756-0500-6-236
Ford, J., Algert, C., Kok, C., Choy, M., & Roberts, C.
(2012). Hospital Data Reporting on Postpartum Hemorrhage: Under-Estimates Recurrence and Over-Estimates the Contribution of Uterine Atony. Maternal & Child Health Journal, 16(7), 1542-1548. doi:10.1007/s10995-011-0919-1
Ford, J. B., Shand, A. W., & Roberts, C. L. (2013). Characteristics, causes and treatment of postpartum haemorrhage in first and second pregnancies. Australian & New Zealand Journal Of Obstetrics & Gynaecology, 53(1), 90-93. doi:10.1111/ajo.12019
Fyfe, E., Thompson, J., Anderson, N., Groom, K., & McCowan, L. (2012). Maternal obesity and postpartum haemorrhage after vaginal and caesarean delivery among nulliparous women at term: a retrospective cohort study. BMC Pregnancy And Childbirth, 12112. doi:10.1186/1471-2393-12-112
RATH, W. H. (2011). Postpartum hemorrhage - update on problems of definitions and diagnosis. Acta Obstetricia Et Gynecologica Scandinavica, 90(5), 421-428. doi:10.1111/j.1600-0412.2011.01107.x
Tae-Hee, K., Hae-Hyeog, L., Jun-Mo, K., Ae-Li, R., Soo-Ho, C., & Woo Seok, L. (2013). Uterine artery embolization for primary postpartum hemorrhage. Iranian Journal Of Reproductive Medicine, 11(6),
511-518.

References von Schmidt auf Altenstadt, J. F., Hukkelhoven, C. M., van Roosmalen, J., & Bloemenkamp, K. M. (2013). Pre-Eclampsia Increases the Risk of Postpartum Haemorrhage: A Nationwide Cohort Study in The Netherlands. Plos ONE, 8(12), 1-10. doi:10.1371/journal.pone.0081959