Risk factors for postpartum hemorrhage caused by uterine atony

Abstract

Pregnancy and childbirth are physiological processes experienced by women, but it does not rule out complications resulting in maternal death. One of the causes of maternal death is postpartum hemorrhage. Previous studies have found that postpartum hemorrhage is closely associated with uterine atony. This study aims to explore risk factors for postpartum hemorrhage caused by uterine atony. A case-control study design in Dr. Soetomo General-Academic Hospital. Patient medical records for a period of 2 years at the Dr. Academic General Hospital Soetomo Indonesia used and divided into case and control groups with a ratio of 1:2. Chi-square analyses odds ratios were calculated. A total of 32 patients with uterine atony and 64 medical records without uterine atony were studied. The results of statistical tests on several factors related to postpartum hemorrhage due to uterine atony showed that advanced maternal age (>35 years) (p= 0.763; 95% CI 0.474 – 2.768), grand multipara parity (p = 0.238; 95% CI 0.583-8.185), anemia with Hb <11 (p=0.027; OR=5.000. 95% CI 1.073–23.303), uterine overdistention including macrosomia, polyhydramnios, or gemelli (p=0.031; OR=2.647, 95% CI 1.081-6.482), accelerated labor (p=0.884, 95% CI 0.396-2.221, and previous history of postpartum hemorrhage (p=0.047; OR= 2.435, 95% CI 1.003 – 5.933). This case control study found that anemia, uterine overdistention, and a previous history of postpartum hemorrhage may increase the risk of postpartum hemorrhage due to uterine atony. Therefore, it is recommended to the public to increase awareness of the importance of early and regular pregnancy check-ups, especially in the management of anemia and to identify risk factors.