Postpartum hemorrhage in Suriname: A national descriptive study of hospital births and an audit of case management

Abstract

Background Postpartum hemorrhage (PPH) is the leading cause of direct maternal mortality globally and in Suriname. We aimed to study the prevalence, risk indicators, causes, and management of PPH to identify opportunities for PPH reduction. Methods A nationwide retrospective descriptive study of all hospital deliveries in Suriname in 2017 was performed. Logistic regression analysis was applied to identify risk indicators for PPH (≥ 500ml blood loss). Management of severe PPH (blood loss ≥1,000ml or ≥500ml with hypotension or at least three transfusions) was evaluated via a criteria-based audit using the national guideline. Results In 2017, the prevalence of PPH and severe PPH in Suriname was 9.2% (n = 808/8,747) and 2.5% (n = 220/8,747), respectively. PPH varied from 5.8% to 15.8% across the hospitals. Risk indicators associated with severe PPH included being of African descent (Maroon aOR 2.1[95%CI 1.3–3.3], Creole aOR 1.8[95%CI 1.1–3.0]), multiple pregnancy (aOR 3.4[95%CI 1.7–7.1]), delivery in Hospital D (aOR 2.4[95%CI 1.7–3.4]), cesarean section (aOR 3.9[95%CI 2.9–5.3]), stillbirth (aOR 6.4 [95%CI 3.4–12.2]), preterm birth (aOR 2.1[95%CI 1.3–3.2]), and macrosomia (aOR 2.8 [95%CI 1.5–5.0]). Uterine atony (56.7%, n = 102/180[missing 40]) and retained placenta (19.4%, n = 35/180[missing 40]), were the main causes of severe PPH. A criteria-based audit revealed that women with severe PPH received prophylactic oxytocin in 61.3% (n = 95/155[missing 65]), oxytocin treatment in 68.8% (n = 106/154[missing 66]), and tranexamic acid in 4.9% (n = 5/103[missing 117]). Conclusions PPH prevalence and risk indicators in Suriname were similar to international and regional reports. Inconsistent blood loss measurement, varied maternal and perinatal characteristics, and variable guideline adherence contributed to interhospital prevalence variation. PPH reduction in Suriname can be achieved through prevention by practicing active management of the third stage of labor in every birth and considering risk factors, early recognition by objective and consistent blood loss measurement, and prompt treatment by adequate administration of oxytocin and tranexamic acid according to national guidelines.

Could Subtle Obstetrical Brachial Plexus Palsy Be Related to Unilateral B Glenoid Osteoarthritis?

“…The literature search yielded 449 articles after duplicates removal ( Figure 2 ). More than 75% of these articles were excluded following title or full-text screening ( n = 259 and n = 81, respectively), leaving a total of 109 studies for further analyses ( Table S1 ) [ 16 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ,…”

An analysis of obstetric practices and outcomes in a deep rural district hospital in South Africa

“…Using a 95% confidence level, power of 0.99, margin of error of 5% and an allocation ration of 1:3.57 (reflecting the actual proportions in each arm of the study population), the estimated sample size was 555. This was determined using the difference of proportions of post-partum haemorrhage (PPH) in each arm from the literature [ 12 ]. Systematic random probability sampling of the labour ward delivery register was used to select MCRs.…”

Race/Ethnicity as a Risk Factor in the Development of Postpartum Hemorrhage: A Thorough Systematic Review of Disparity in the Relationship Between Pregnancy and the Rate of Postpartum Hemorrhage

“…This shows that African American women have fewer cases of atonic hemorrhage than Caucasian women. But when they experience atonic hemorrhage, it is much more severe, which can be explained in part by the greater proportion of comorbidities that increase the likelihood of atonic hemorrhage mandating transfusion or hysterectomy (e.g., fibroids, preeclampsia, and preexisting anemia) [ 5 , 9 , 13 ].…”

“…PPH can also be classified as the third or fourth stage, depending on if it develops before or after the delivery of the placenta [ 7 , 8 ]. Therefore, the most prevalent etiologies are classified as primary or secondary causes in Table 1 [ 6 , 9 ].…”