Estudo da hemorragia puerperal: seus fatores de risco e perfil epidemiológico em uma maternidade de referência

Abstract

Introduction: Postpartum hemorrhage (PPH) is a prevalent health problem and is associated with significant morbidity and mortality. Maternal mortality from PPH is an important indicator of a nation's health, as it highlights inequalities in access to health care, as well as a lack of public health policies towards maternal and perinatal health. Objective: To analyze the cases of PPH that occurred in women who gave birth in a reference maternity hospital and compare those who presented PPH with those who did not. . Secondly, to assess the occurrence of PPH by risk groups, following the implementation of a classification system at admission. Method: This is a retrospective cohort study, involving a database with all deliveries that took place at the Hospital das Clínicas of the Federal University of Minas Gerais (UFMG) from September 2019 to December 2020. The classification of the Zero Maternal Death due to Hemorrhage Program (ZMDHP) was implemented in this maternity hospital in September 2019. The classification into low, medium and high risk for PPH was performed automatically through an electronic medical record called SISMater®. The occurrence of PPH was calculated and compared among the participants, grouped according to obstetric and clinical characteristics and risk factors. Results: One thousand nine hundred and thirty six women who gave birth were included in the analysis. The prevalence of postpartum hemorrhage was 6,8% (167 participants). According to multivariate analysis, the odds for PPH was significantly higher in participants who presented multiple pregnancy (OR 2.88, 95% CI 1.28 to 6.49), active bleeding on admission (OR 6.12, 95% CI 1.20 to 4.65), non-cephalic presentation (OR 2.36, 95% CI 1.20 to 4.65), retained placenta (OR 9.39, 95% CI 2.90 to 30.46) and placental abruption (OR 6.95, 95% CI 2.06 to 23.48). Vaginal delivery figured out as a protective factor (OR 0.58, 95% CI 0.34 to 0.98). Regarding the risk stratification strategy adopted at the admission, there was no statistically significant relationship between the “high”, “medium” and “low” risk classifications and the occurrence of PPH (p=0.119). Conclusions: The main contribution of our study was reinforcing the magnitude of the PPH in a sample of Brazilian pregnant women in a reference maternity and rising risk factors at hospital admission. It is possible that the absence of a relationship between the risk rating category and the frequency of PPH indicates some effect of the ZMDP actions.