Abstract:
Introduction. Postpartum hemorrhage (PPH) is one of the leading obstetric complications,
affecting 5-15% births. Being a major factor in maternal mortality and morbidity, PPH causes
about 25% of maternal deaths worldwide.
Aim of study. The aim of the study was to assess the cases of PPH in multiparous women, admitted
to the Tertiary Perinatal Center.
Methods and materials. The retrospective study was performed by assessing 81 clinical cases of
PPH in multiparous women. Total blood loss in labor or C-section was performed by using
graduated vessels, and all the sterile material used was weighted. For continuous variables, the
mean values and standard deviation of the mean were calculated; the median (Me) as well as the
interquartile range (Q1;Q3) in the case of a distribution of characteristics that differs from the
normal.
Results. The average age of women was 31.6±5.5 years (Me 32 (28;35.5)), varying in the limits
of 20-42 years. The majority of participants delivered for the second time - 38 cases (46.9% (95%
CI 33.3-59.9)), however, 30 women (37.0% (95% CI 25.9-48.2)) gave birth for the third time, and
13 women (16.1% (95% CI 8.5-27.4)) had 4th – 9th delivery. In 41 cases (50.6% (95% CI 40.7-
61.7)) a c-section was performed. The mean blood loss in vaginal delivery was 850±308 (Me 800
(600;1050)) mL, varying in the limits of 500– 1600 mL. Compared to the mean blood loss in Csection
– 1752±1093 (Me 1500 (1100;1850)) mL, varying in the limits of 1000 – 5250 mL. In the
structure of PPH there were assessed 26 cases (32.1% (95% CI 20.9-47.0)) of the placental defect
or placenta adherens, 15 cases (18.5% (95% CI 10.3-30.5)) of lacerations of the birth canal, 11
cases (13.6% (95% CI 7.4-23.4)) of uterine atonia, and 2 cases (2.5% (95% CI 0-7.3)) of uterine
rupture. Hence, in 46 women (56.8% (95% CI 44.6-69.1)) it was applied conservative management
of the cases. However, in 20 cases (24.6% (95% CI 15.0-38.1)) an operative management was
applied, from which 7 cases (8.6% (95% CI 3.7-14.7)) hemostatic sutures were applied. In 13 cases
(16.0% (95% CI 8.5-27.4)) hysterectomy was performed, from which 9 cases (69.2% (95% CI
31.6-100)) subtotal hysterectomy without annexes was the elective method for definitive
hemostasis.
Conclusion. PPH is a major obstetric complication, which occurs more frequently in multiparous
women, in association with placental pathology and birth canal trauma, explained by
overextension of the uterus and coagulation disorders, requiring extensive surgical management.
