Risk factors associated with the development of postpartum hemorrhage. A single-center observational study.

Abstract

Introduction: Postpartum hemorrhage is recognized as one of the leading causes of morbidity and mortality in low-income countries. It is defined as blood loss of 500 ml or more during the physiological postpartum period, 1000 ml or more during the immediate postpartum period, and blood loss, irrespective of volume, that leads to hemodynamic instability in postpartum women after childbirth or cesarean section. This study aimed to identify the causes and complications of postpartum hemorrhage among postpartum women aged 15--45 years at Dr. León Becerra General Hospital in Milagro, Ecuador, from February 2018–February 2020.

Methodology: This observational, retrospective study was conducted at the León Becerra Hospital in Milagro (Ecuador) from January 2018 to December 2020. The study included women aged 15 to 45 years with postpartum hemorrhage. The risk factors were maternal age, gestational age, multiple gestations, medical history, delivery route, and comorbidities. The sample was probabilistic, and descriptive statistics were used.

Results: In 34 patients, 62% were between 15 and 25 years old, 29% were between 26 and 35 years old, and 9% were between 26 and 35 years old. There were multiple pregnancies in 68% of the cases and optimal prenatal care in 70%; most cases involved vaginal delivery (71%). A total of 56% (n=19) had no risk factors, with prolonged delivery (17%) (n=6), followed by previous cesarean sections (12%) (n=4). Anemia and hypovolemic shock accounted for 84% of the complications. The cause of hemorrhage was uterine tone failure in 59% of the patients.

Conclusions: These findings underscore the importance of surveillance and early intervention in young and multigestating women, as well as the need for effective preventive and management strategies for uterine atony and other causes of postpartum hemorrhage, to reduce the incidence of serious complications such as anemia and hypovolemic shock.