2023-05-09 20:00:06
- Obstetric hemorrhage is the leading cause of maternal mortality in low-income countries and the primary cause of nearly a quarter of all maternal deaths worldwide.
- Its prevention is part of the WHO Millennium Development Goals.
- The maternal mortality rate for this cause is 24.7% of the cases in Mexico.
One of the first three causes of maternal mortality in the world is obstetric haemorrhage. It is defined as blood loss of 500 ml or more within 24 hours after delivery or 1000 ml after caesarean section. While a severe or serious is the loss of blood of 1500 ml or more within the same period. In most cases they could be avoided through timely and appropriate treatment.
According to the WHO, improving health care for women during childbirth to prevent and treat this problem represents a necessary step towards compliance with the Millennium Development Goals.
Obstetric hemorrhage affects approximately 2% of all women in labor. In Mexico it is considered the leading cause of preventable maternal death, with 24.7% of the cases. Among the main causes are uterine atony, which occurs when the uterus does not contract after childbirth; retained placenta; injuries to the uterus or vaginal canal during childbirth, and coagulation disorders or coagulopathies.
The obstetric hemorrhage it is a significant contributing factor to severe maternal morbidity and long-term disability, as well as a number of other serious maternal conditions generally associated with considerable blood loss, including shock and organ dysfunction.
Prevention, key piece
To elaborate on the importance of prevention and treatment of postpartum hemorrhage“Uterine atony is the most common cause of obstetric hemorrhage, but genital trauma, uterine rupture, retained placental tissue, and disorders Maternal coagulation disorders can also cause postpartum hemorrhage, these primary causes can be more easily remembered as the 4 T’s: Tone, Tissue, Trauma and Thrombin.
He also pointed out that, in the case of postpartum hemorrhage where the cause is linked to a coagulation disorder, its identification is usually more complex, since within the 4 primary causes they are the least frequent. They are not always suspected and therefore there is a delay in timely treatment.
Among the coagulation disorders that should be suspected in the event of postpartum hemorrhage where the cause is not anatomical are: acquired hemophilia, congenital deficiency of coagulation Factor VII, Glanzmann’s thrombasthenia, von Willebrand disease and congenital hemophilia, to name a few. some.
Suspecting coagulation disorders when the rest of the causes have been ruled out is key to being able to provide timely treatment and avoid maternal deaths. Although most women who have complications from obstetric hemorrhage have no identifiable clinical risk factors or history, having more than two births and multiple gestations are associated with an increased risk of postpartum bleeding.
According to Dr. Mendoza, a treatment approach should be aimed at resolving the most frequent causes, such as uterine disorders, retained placenta, birth canal injuries, but women should not be left aside. coagulopathies, since it is seldom thought that the origin of the bleeding may be a coagulation disorder.
“With proper treatment, diagnosed patients can avoid severe postpartum hemorrhage. In Mexico we have different therapeutic options to treat these patients, such as activated recombinant Factor VII (Novo Seven) and the derivative of the prothrombin complex. If the woman develops postpartum hemorrhage, these drugs are highly effective in stopping the bleeding.”
These tests should be done every three months throughout the pregnancy. If from the beginning it is detected that the coagulation test does not show normal parameters, the patient must be referred to the hematologist, who will be responsible for the diagnosis and treatment of coagulation diseases.
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