POSTPARTUM HEMORRHAGE

Postpartum Hemorrhage: Prevalence Rates And Risk Factors In Hispanic And Non Hispanic Mothers

[Onyi Nwogu, RN, PHN, MSc, Deepika Goyal, PhD, RN, FNP, and Ruth Rosenblum, DNP]

ABSTRACT

Background: Postpartum hemorrhage (PPH), defined as blood loss of more than 500 ml following Vaginal delivery or more than 1000 ml following Cesarean delivery, is the single most cause of maternal mortality worldwide. Risk factors include dysfunctional labor, cesarean section, pre-eclampsia, gestational diabetes, retained placenta fragments, prolonged induction of labor, uterine atony, multiple gestation, and placenta previa. This study aims to identify risk factors associated with PPH among Hispanic and Non Hispanic mothers.

Methods:. A retrospective descriptive quantitative study was conducted in a large teaching hospital located in Northern California. A review of medical records of 452 women admitted to the labor and delivery unit between January 1, 2009 and December 31, 2009, with a diagnosis of postpartum hemorrhage was conducted. Predictor Variables examined in this study were: race, socio-economic status, type of postpartum hemorrhage and Mode of delivery, age, marital status and religion. The outcome Variable was PPH.

Results: Predictor variables race and insurance status were not significant predictors of PPH. However, cesarean section was associated with a higher unadjusted odds ratio of postpartum hemorrhage than vaginal delivery but the adjusted odds ratio was not significantly higher. Interestingly, the adjusted odds ratio of immediate PPH as compared to delayed PPH was 1.7 times higher with everything else held equal.

Conclusion: Race and socio-economic status were not significant predictors of post partum hemorrhage in our sample. A prospective study is needed in our patient population to address this important question of predictors of postpartum hemorrhage in Hispanic vs non Hispanic women.

Table of Contents

ABSTRACTii

INTRODUCTION:1

LITERATURE REVIEW:3

STUDY DESIGN AND METHODS6

Design6

Sample6

Methodology6

DATA ANALYSIS8

Exploratory data analysis13

RESULTS:14

Discussion15

Clinical Implications17

Research Limitations/Implications19

CONCLUSION22

REFERENCES24

Appendices27

Table 127

Table 327

Table 428

Table 5b30

Figure Legend31

INTRODUCTION:

Postpartum hemorrhage (PPH), defined as blood loss of > 500 ml following vaginal delivery or > 1000 ml following cesarean delivery, is considered one of the leading causes of maternal mortality in the United States (Smith & Brennan, 2009). PPH affects 25% of mothers in the United States (Guendelman, Thorton, Gould, & Hosang, 2006) and costs exceed millions of dollars per year. Known risk factors related to PPH include hypertension, retained placenta, pre-eclampsia, sepsis, uterine myomas, and uterine atony (Wilde, 2005; Berg, MacKay, Qin, & Callagan, 2009). According to Devine (2009), PPH occurs in response to an abnormality of one of the four processes called the “4” Ts - Tone (abnormal uterine contractility); Tissue (retained products of tissue); Trauma (genital tract trauma); and Thrombin (abnormalities of coagulation). Tucker and colleagues (2007) examined prevalence and case fatality rates among Black and White women for preeclampsia, eclampsia, abruption placentae, placenta previa, and postpartum hemorrhage for the years 1988 to 1999. Prevalence rate was defined for each of the 5 selected conditions as the number of pregnant women with the condition per 100,000 live births. Although there was no statistically significant difference in prevalence rates between Black and Caucasian women, results suggested Black women with PPH were 2-3 times more likely to ...