RISK FACTORS AND PROTECTIVE FACTORS FOR REFRACTORY POSTPARTUM HEMORRHAGE

Objective: To study the incidence of refractory postpartum hemorrhage (PPH) at a tertiary-level hospital and identify its risk factors and protective factors. Materials and methods: In the first stage, a cross-sectional study was conducted to assess the incidence of PPH and refractory PPH in a tertiary-level hospital. This study included all patients who delivered between 2019 and 2022 (n=15,480). In the second stage, a retrospective case-control study was conducted with 220 patients to assess the protective and risk factors for refractory PPH. Using univariate binary logistic regression analysis, 178 clinical, anamnestic, and laboratory factors were evaluated. Results: The incidence of PPH in tertiary-level hospital was 0.67%, while the incidence of refractory PPH was 0.36%. Significant risk factors for refractory PPH were placenta accreta – OR 23.77 (95% CI 2.85–198.01), p=0.003 and augmentation of labor – OR 17.09 (95% CI 1.43–204.16), p=0.02. In addition, significant risk factors for refractory PPH were placental abruption – OR 13.87 (95% CI 2.85–67.56), p<0.001; uterine hypotony during cesarean section – OR 10.0 (95% CI 3.04–32.94), p<0.001; placenta adhaerens – OR 9.48 (95% CI 2.36–38.04), p=0.002; placenta previa – OR 4.81 (95% CI 1.9–12.16), p<0.001; cesarean delivery – OR 4.61 (95% CI 2.3–9.23), p<0.001; Uterine scar after Cesarean section – OR 4.48 (95% CI 2.32–8.65), p<0.001; cesarean delivery due to severe preeclampsia – OR 4.03 (1.04–15.57), p=0.04. The protective factors for refractory PPH included vaginal delivery – OR 0.22 (95% CI 0.11–0.43; p<0.001), fibrinogen level – OR 0.65 (95% CI 0.47–0.91; p=0.01), and gestational age – OR 0.85 (95% CI 0.74–0.98; p=0.02). Conclusion: Risk factors for refractory postpartum hemorrhage (PPH) include abnormal placentation (such as placenta accreta, placenta increta, placenta percreta, and placenta previa), augmentation of labor, cesarean delivery, cesarean delivery due to severe preeclampsia, placental abruption, the presence of a post-cesarean uterine scar, and uterine hypotony during cesarean section. Protective factors include gestational age, vaginal delivery, and fibrinogen level. © A group of authors, 2024.