CAUSAL STUDY OF POSTPARTUM HEMORRHAGE AFTER VIRGINAL DELIVERY

CAUSAL STUDY OF POSTPARTUM HEMORRHAGE AFTER

VIRGINAL DELIVERY

Hanaa Mohammed Haider*and Nadia Ali Mohammed*

Minatory of Health-Baghdad Health Department Alresafa-AL-Shaheed Dari Al-Fayad Hospital, Baghdad, Iraq.

ABSTRACT

This study was conducted to study all the causes leading to the disappearance of placenta in order to apply all appropriate treatments for each reason and thus avoid the complications of death, and study the risk factors for bleeding to achieve the best way to prevent and prepare for it and prevent or reduce bleeding. This study included 77 patients admitted to AL –JARAH AL – AHLY HOSPITAL and one who had a bleeding after the birth of vaginal birth, including (12) bleeding after a vaginal birth outside the hospital during the period of study: from 2014/1/1 to 1 / 1/2016, and excluded only those patients who were born with bleeding. To determine the rate of occurrence of placenta bleeding between vaginal deliveries in the hospital, and we have not been able to determine the incidence of placenta bleeding outside the hospital and then study all the reasons leading to bleeding, and the most common cause is uterine inactivity (5, 18%), followed by ruptures and bruises (31, 17%), followed by retention of partial or total placenta by (11, 629%). The reversal of the uterus was the least common cause, where we found only two cases. (2%, 66%). The cases studied by hemorrhage to hemorrhage and degree of hemorrhage (p-value less than 0, 015). Most cases of light bleeding were due to uterine inactivity and most cases of severe bleeding due to genital tract trauma. "Department of Obstetrics and Gynecology, Faculty of Medicine.

KEYWORDS: Placenta hemorrhage, placenta default, placenta retention, Invert the soles of the uterus.

Volume 8, Issue 8, 970-979. Research Article ISSN 2277– 7105

Article Received on 18 May 2019,

Revised on 08 June 2019, Accepted on 28 June 2019,

DOI: 10.20959/wjpr20198-15338

*Corresponding Author

Hanaa Mohammed Haider

Minatory of

Health-Baghdad Health Department

Alresafa-AL-Shaheed Dari

Al-Fayad Hospital,

INTRODUCTION

The placenta bleeding (PPH) is one of the most common, most dangerous and most common birth defects, and continues to be the leading cause of parental death, accounting for 35% of maternal deaths from bleeding during pregnancy. The percentage increases in poor areas with medical expertise and services, and by the necessary means of transportation. It is not surprising that women die within two hours of bleeding if they do not receive proper treatment. Bleeding is defined as the loss of more than 500 ml after vaginal delivery and 1000 ml postpartum cesarean section 1 and is estimated to occur in the United Kingdom (3.9%) after vaginal delivery and (6.4%) after Cesarean section. The causes of hemorrhagic hemorrhage are classified as follows:

1- Tore: 70% of the causes, usually the blood accumulates inside the uterus, and does not appear outside the visible genitalia except the simple part, For the occurrence of both hyperplasia of the uterine muscle and the multiplicity of births and induction of labor and etc. 2. Trauma: and constitute 20% of the causes, and include the vaginal and perineal antennas and commented Rah And the uterus, especially the birth of assisted by tools and defective bodies and rapid delivery and the extension of the ejaculation of the vulva suffice, and here is the bleeding with red blood Ghana shed visible genitalia to clot there:

3 - Tissue: and constitute 19% of the causes and include the survival of choroid, placenta conjunctiva, Uterine rupture, uterine rupture, and the larger the chorionic segments, the earlier and more severe hemorrhagic disorders were found. Attention should always be paid to the issue of hemorrhage because excessive and rapid blood loss causes a severe reduction in parental blood pressure, leading to trauma and even death if not treated. However, it is rare that this hemorrhage appears to be a mass, but it is usually mild or moderate, which deceives the doctor at first sight. Therefore, patients should be identified with risk factors and bleeders to take preventive and curative measures, accelerate the cause of bleeding and stop and compensate for lost blood.

The importance of research and its objectives The importance

Research Objectives

To study all the causes leading to the disappearance of salvation in order to apply all appropriate treatments according to each reason and thus avoid the complications of death and death. Study the risk factors for hemorrhage in order to achieve the best way to prevent and prepare for it and prevent or reduce bleeding. Research Methods: The research item includes 77 acceptable cases at AL –JARAH AL – AHLY HOSPITAL IN BAGHDAD and a person who has an initial hemorrhage after a vaginal birth, including (12) bleeding after a vaginal birth outside the hospital. We excluded cases of bleeding after cesarean delivery. METHODS: Based on the statistical conclusion of the studied sample of all pregnant women who were born vaginal and mingled and delivered with a diagnosis of clinical and laboratory diagnosis. All data were taken on the identity of the patient and her general condition, clinical examination and the female examination necessary to diagnose the cause of hemorrhage. Take a complete clinical story about the current pregnancy story and the obstetric and pathological precedents that increase the risk of hemorrhage. All previous data have been released in a specific case search form. Search results will be displayed in Charts, Charts, and Charts. Place of study: Department of Obstetrics and Gynecology at AL –JARAH AL – SPECIAL HOSPITAL From 2014/1/1 to 1/1/2016.

RESULTS AND DISCUSSION Percentage of incidence

Table 1: The percentage of hemorrhagic incidence.

Cases of PPH Total births Number Percentage of incidence

Births out hospital --- 12 --- Births inside hospital 1845 65 3.52% Total --- 77 ---

We could not determine the incidence of extinction outside the hospital because of the difficulty in determining the number of births outside the hospital.

The causes of placenta hemorrhage

Table 2: Show the causes of placenta bleeding.

Causes of placenta hemorrhage Number Percentage

placenta default 37 48,5% rupture and bruising of the reproductive tract 24 31.17% placenta retention 14 18,18% uterus wall turns, 2 2,60% blood clotting --- ---

Total 77 100%

The causes of placenta hemorrhage placenta default, rupture, and bruising of the reproductive tract, placenta retention and blood clotting.

Diagram 1: The causes of placenta bleeding.

The relationship between the degree of hemorrhage and the cause of hemorrhage: the division of the studied cases by cause into groups: uterine inertia, genital tract trauma, partial or total placenta retention, intrauterine subluxation of the uterus and evaluation of the general condition and degree of hemorrhage.

Table No (3): Show the relationship between the degree of placenta bleeding and the cause of it.

Total Severe hemorrhage Medium

hemorrhage Simple hemorrhage Cause of hemorrhage

Percentage Number Percentage Number Percentage Number Percentage Number

48.05% 37 25% 1 60% 9 46.55% 27 placenta default

31.17% 24 50% 2 33.33% 5 29.31% 17

rupture and bruising of the reproductive tract 18.18% 14 --- --- 6.66% 1 22.41% 13 placenta retention

We find that the most causes of Simple hemorrhage were by placenta default 46.55% Followed by genital tract trauma (29, 31%), and placenta retention 22.41% while the Uterus turning (1.72%). In cases of moderate bleeding, 9 cases were caused by uterine inertia (60%), genital tract trauma (33%, 33%), and one condition due to placental retention, whereas severe hemorrhage was mostly due to trauma (2 cases) (50%), one condition due to uterine inertia (25%), and a condition due to overturning of the uterus (25%). The relationship between the cause of hemorrhage and hemorrhage was statistically significant (p-value less than 0, 05), where there are statistically significant differences between the previous ratios.

Data Diagram No 1: Shows the bleeding during the four cases which are studied according the causal Placenta damage placenta uterus turning Default p.tract retention.

In terms of uterine inertia, we have been prepared to find that induction of labor is at the forefront of the causes (24, 32%). Hence we conclude the importance of emphasizing the avoidance of induction of labor only with the presence of indications and conditions and the right of expert and with close monitoring to avoid the complications resulting from its use, Followed by prolonged labor (18, 92%), uterine hyperplasia (13.5%), and neonatal anesthesia in only two cases (5. 40%)., 2.70%), but we found that a high percentage of cases of emphysema were unknown without any cause (35, 14%).

Table 4: Shows the factors that leads to placenta default.

Causes of placenta default number Percentage

Induction of labor 9

Hyperplasia of the uterus 5 13.515 Prolonged labor 7 18.92% Congenital anesthesia 2 5.40% Uterine fibroelastoma 1 2.70% unknown reason 13 35.14%

Causes of placenta default 35.14%/2.70%/2.70%/5.40%/18.92%/13.515/24.32% Data diagram (2) shows Causes of placenta default.

The damage of reproductive tract

We have 25 cases of placenta hemorrhage the most common factors leading to placenta hemorrhage due to genital tract trauma were the first birth (29, 17%), and the vaginal vasectomy was performed (29, 17%). (15%), followed by genital tract trauma (16,67%), then fetal birth (12.5%). The birth of an irregular arrival had only two cases and the arrival were quadratic. (33%), this indicates the importance of sufficient experience when generating high risk to avoid bleeding and the following serious complications cases.

Table No 5: Shows the causes of reproductive tract damage.

Causes of reproductive tract damage Number of cases Percentage

Usage of needles 7 29%

Vulvovascular biopsy 6 25% Abnormal of coming of embryo 2 8.33%

Huge employ 3 12.5%

Shoulders obstacle 2 8.33% Previous damage of tract 4 16.67%

Total 24 100%

Diagram No 3: Shows the causes of reproductive tract damage.

The statistical study and previous factors were found to be statistically significant. A square kay test (0, 05> p-value) was applied.

Retention of the placenta, partial or wholly

Table No 6: Shows the dangerous factors of placenta retention.

Dangerous factors of placenta retention Number of cases Percentage

Virginity birth 6 42,86

Induction of labor 3 21,43

Death of embryo 4 28.57

Previous effect of Caesarean births 1 7.14 Non –dangerous factors ---- ---

Total 14 100%

Diagram No 4: Shows the dangerous factors of placenta retention.

In the previous table, we found that the most promising factors for the retention of cerebral remains in the studied cases were early childbirth (<37 weeks gestational), where we found (6) cases (42,86%)., 57%). In induction of labor, I found (3) cases of partial placenta (21.43%). Finally, we found a previous cesarean in one case of placental retention as the cause of bleeding (7, 14%). Indicates the importance of careful interrogation and take the clinical story with interest, and know the age of pregnancy accurately and the patient's history of the disease, and be sure to not remain the weave and post-natal occlusion after the presence of predisposing factors.

Table NO 7: Shows Comparison between the causes of placenta bleeding in this study with the study of Dr. Rose and study of Dr. Rawa Hubra.

study of Dr. Rawa

Hubra study of Dr. Rose Our study

Cause of placenta hemorrhage

38, 16% 60% 48, 05% Causes of bleeding 29, 79% 20% 31, 17% uterine default

15, 91 19% 11, 69%

Tearing and rupture of the reproductive tract

3, 18% --- ----

partial or total, Relation of the placenta

Where uterine inertia was attributed to Rose However, we find that trauma and rupture in the reproductive pathway are higher in our study than in the two studies. It is worth noting here that each of the other two studies examined salvation without excluding cesarean delivery. While our study was limited to vaginal delivery and excluded cesarean delivery. Comparison of causes of uterine inertia:

Table NO 8: Show the comparative between causes of placenta bleeding between our study and the study of Dr. Rawa Hubra.

Causes of placenta default Our study Study of Dr. Rawa Hubra

Induction of labor 24, 32% 24,16% Introduction of pregnancy shaking 13, 51% 23, 36%,

Infection --- 8.41%

Prolonged labor --- 10.28% Congenital anesthesia 18, 92% 5.54 The placenta defective 5, 40% 3,73 placental dislocation default --- 3,73 Early placental dislocation ---- 8.41 Hyperplasia of the uterus 2, 70% 0.93 unknown reason % 35, 14 8.41

We can see in above table that the study of Dr. Rawa Hubra 2000/2002, in AL –JARAH AL – SPECIAL HOSPITAL / BAGHDAD induction of labor in the forefront of causes of uterine inertia, and then hyperplasia of the uterus, and then the introduction of eclampsia and the early placenta and the absence of uterine placenta, and then prolonged labor, and finally the defective basis of placenta and obstetric anesthesia. These results converge slightly from the results of our study, which found the most important causes of inertia also induction of labor.

Table No 9: Shows a comparison between the important factors of reproductive tract damages between our study and the study of Dr. Zetterstrom.

Causes of reproductive

tract damage Our study Study of Dr. Zetterstrom

Usage of needles 29.17 25,15% Vulvovascular biopsy 25 20,11% Abnormal of coming of

embryo 8.33 6,23%

Huge employ --. 20,45% Shoulders obstacle 12,5 8% Previous damage of tract 8,33 3.77%

In the previous table we compared the results of our study with Dr. Zetterstrom in the Stockholm Hospital in 2002 [8], and we found the results of the approach, where the most important factors Achromat and parenchyma protective, and then precedence of genital tract trauma and then the birth of a fetus and finally defective environments and shoulder muscles. However, in the Stockholm Hospital Study, there was a significant proportion of assisted delivery (20, 11%), while no case of genital tract trauma was associated with the use of tools.

Table No 10: Shows comparison between placenta retention in our study and the study of Dr. Rawa Hubra.

Dangerous factors of placenta retention Our study Dr. Rawa Hubra study

early birth 42.86 23,08

Induction of labor 21,43 15,38 Death of embryo 28,57 30.77 Previous effect of Caesarean births ---- 15,38 Non –dangerous factors 7,14 15.38 --- ---

CONCLUSIONS

1-The rate of hemorrhage in our study (3, 52%) is fairly low, indicating good birth control, especially the third stage.

2. The most important reasons for the absence of salvation are uterine inertia, then rupture of the reproductive process and the retention of the placenta, and most of the cases we have had bleeding light.

3 The induction of labor is an important risk factor for bleeding, indicating the importance of following the proper rules when instigating and monitoring well. And from all cases of placenta retention, we have had risk factors, the most important of which is early delivery.

Recommendations

1- Obstetricians and gynecologists should educate pregnant women and raise awareness among them, and draw their attention to the purity of salvation as a serious emergency caused by inexperienced hands.

3- School methods should be observed in the management of labor, especially the third round of labor, the placenta is pressed on the uterus, the placenta must be examined well after each birth, and the reproductive pathway is checked to ensure there is no rupture.

4- Do not underestimate the amount of postpartum hemorrhage, however minor, and check the source of bleeding and monitoring the contraction of the uterus well after each birth, especially in pregnant women are at risk of the occurrence of uterine inactivity.

5- Care should be taken to perform the procedure correctly and with expert hands to avoid ruptures caused by the extension or tumors caused by improper repair.

6- It is preferable to perform a sedated procedure after each birth in the following cases:

 After early deliveries.

 Death of the pregnancy crop:

Each vaginal delivery followed by cesarean section, especially in cases of unexplained bleeding after birth.

REFERENCES

1. JHPIEGO K. Prevention PostPartum Haenior - v - liage, Active management of third stage of labor, 2001, <http: / www. sciencedirect. com html>

2. ARTHER, J. M; EVANS, M. D; KENNETH, R. Manual of Obstetrics edition, The Puerperium Postpartum Complications, postpartum hemorrhage, 2000, p.484.

3. Gynecologic. Chapter (8), hemorrhage, 1997, p. 4 - MAAME, Y. A, B Yiadom, MD, MPH Staff Physician, Department of Emergency Cooper University Hospital, 2002, p. 4. Dr. Ruwa Hebra - 2002 – placenta bleeding (Causes, complications, management, and

prevention).

5. 2014 - A comparative study of oxytocin and misoprostol in the prevention of hemorrhage 6. D - Dima Sallum – placenta. bleeding prevention in women at childbirth,