Factors associated with lethality related to immediate postpartum hemorrhage in obstetric settings in four hospitals in Brazzaville

Abstract

 Introduction. Immediate postpartum hemorrhage is an obstetric emergency and is responsible for high maternal mortality. This study aimed to analyze the factors associated with immediate postpartum hemorrhage (IPH) lethality in obstetric settings in four hospitals in Brazzaville. Patients and Methods. This was a multicenter, analytical cross-sectional study conducted from January 
1, 2020, to December 31, 2022, including women who had experienced IPH from a theoretical term of 28 weeks of amenorrhea. The variables studied were pre-, intra-, and postpartum. The odds ratio and its lower 95% confidence interval were calculated for a probability p-value less than 5%, considered significant.  Results. One hundred and eighty women who had immediate postpartum hemorrhage were collected, of whom 31 died, i.e. 17.2%. The deceased were different from the living in age [31 years (26.36) vs. 35 years (28.38); p<0.05] with a predominance of women aged ≥ 35 years (ORa=2.2 [1.5 - 5.7]; p<0.05) and mostly multiparous (ORa=3.8 [2.2 - 6.7]; p<0.05). Almost all women gave birth in a hospital setting Key words: Pregnancy-Ovarian cyst-Laparoscopy-Hemoperitoneum (100% vs. 96%; p>0.05). Women who had an altered general condition were at greater risk of dying (ORa=10.2 [5.1 - 26.8]; p<0.05). Similarly, the increased risk of death from hemorrhage was associated with hypovolemic shock (aOR=20 [7.6 – 35.2]; p<0.05), retroplacental hematoma (aOR=3.5 [1.5 – 14.8]; p<0.05) and intrauterine fetal death (aOR=2.6 [1.3 – 7]; p<0.05). The risk of death was higher in cases of associated hemostasis disorders (aOR=9.5 [3.6 – 21]; p<0.05) and uterine rupture (aOR=3.1 [1.4 – 8.1]; p<0.05).  Conclusion. Reducing maternal mortality related to immediate postpartum hemorrhage would require improving the time to treatment and the efficient application of therapeutic strategies to combat immediate postpartum hemorrhage.