Hemorragia Pós-Parto, Causas e Desfechos Maternos: um estudo transversal

Abstract

Introduction: Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide and the second in Brazil, mainly determined by uterine atony, trauma, retained placental tissue, and coagulation disorders. Objective: To investigate the association between the causes of PPH within the first 24 hours and maternal outcomes such as stability in rooming-in care (ALCON), instability while awaiting transfer to the Intensive Care Unit (ICU), and maternal death. Methods: This is a quantitative analytical cross-sectional study. Data collection was conducted from June 2024 to March 2025, based on electronic medical records of postpartum women treated in two public maternity hospitals in the Midwest region of Brazil, from December 2022 to November 2023. Descriptive statistics included absolute and relative frequencies, as well as measures of central tendency and dispersion. Associations between primary dependent variables (Causes: tone, trauma, tissue, and thrombin), secondary variables (Maternal outcomes: ALCON, ICU, and maternal death), and independent maternal variables—sociodemographic (age, marital status, race/skin color) and obstetric (comorbidities, previous obstetric risk, prenatal care, risk for PPH, gestational age, number of pregnancies and abortions, labor and mode of delivery, instrumental delivery, oxytocin use during labor, placental delivery in vaginal birth, intact cotyledons and membranes, prophylactic oxytocin, uterine tone assessment, attending professional at delivery, vital signs during labor, shock index, vital signs in the first hour postpartum, skin-to-skin contact, and breastfeeding in the first hour of life)—were assessed using Poisson regression with robust variance. Results were expressed as Prevalence Ratios (PR) with 95% confidence intervals (95% CI). Undocumented causes of PPH were also analyzed. The significance level was set at 5%. Results: A total of 8,358 medical records were evaluated, and the final sample of women with PPH was 794 (9.5%), of whom 784 (98.7%) had ALCON as outcome and 10 (1.3%) were awaiting ICU transfer. No maternal deaths occurred. The most prevalent causes of PPH were uterine atony 87.8% (697), tissue 6.2% (49), trauma 6.0% (48), and undocumented causes 8.3% (66). Women with uterine atony had an 83% reduction in ICU admission (adjusted PR = 0.17; 95% CI 0.07–0.39; p < 0.001), whereas retained tissue showed a 2.7-fold increase in ICU indication (adjusted PR = 2.70; 95% CI 1.16–6.28; p = 0.022). In the adjusted analysis, the following associations were observed: uterine atony with the assessment of vital signs during labor (adjusted PR = 1.07; 95% CI: 1.01–1.14; p = 0.015); trauma with cesarean delivery (adjusted PR = 0.23; 95% CI: 0.08–0.64; p = 0.005), instrumental delivery (adjusted PR = 2.82; 95% CI: 1.23–6.48; p = 0.015), and an inverse association with breastfeeding in the first hour of life (adjusted PR = 0.57; 95% CI: 0.33–0.98; p = 0.043); retained tissue with previous obstetric risk (adjusted PR = 5.99; 95% CI: 2.93–12.23; p < 0.001) and number of abortions (adjusted PR = 1.51; 95% CI: 1.11–2.06; p = 0.009); and undocumented cause inversely associated with vital signs during labor (adjusted PR = 0.35; 95% CI: 0.20–0.62; p < 0.001) and associated with cesarean delivery (adjusted PR = 2.69; 95% CI: 1.23–5.90; p = 0.014). Conclusion: Most postpartum women had stability in ALCON as their maternal outcome. The main causes of PPH were tone, tissue, and trauma. Study contribution: Understanding the prevalence of causes and outcomes may assist health managers in resource allocation, enabling professionals to address causes and reduce maternal morbidity and mortality due to PPH.