Abstract
Objectives
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. We sought to identify the current definitions, prevalence, risk factors and preventive interventions for PPH.
Methods
We searched the National Guideline Clearinghouse, the Cochrane Library, PubMed and Ichushi Web beginning through November 2011. We performed a systematic literature review. After title and abstract screening, study quality was assessed.
Results
Blood loss from genital tract of 500mL or more in the first 24 hours after the delivery is defined as PPH. Recently in Japan, 800mL or more was diagnostic criteria for abnormal bleeding after vaginal delivery. Severe PPH was defined as 1000 mL or more and was more important in terms of maternal health. The prevalence of PPH, (blood loss over 1000 mL after vaginal delivery), in Japan was 2-5 %. Risk factors identified during pregnancy were: macrosomia, recurrence of PPH, multiple gestation, grandmultiparous (4 and more), maternal age over 35 years, low-lying placenta, polyhydramnios, antepartum hemorrhage, obesity (BMI is 25 and over), severe anemia, uterine myoma, and history of cesarean-section, PIH (Pregnancy Induced Hypertension), post-term delivery. Prolonged first and second stage labor, prolonged third stage labor, chorioamninitis, induction of labor, assisted delivery retained placenta, anomaly of the rotation, vaginal laceration and Kristeller maneuver were risk factors identified during delivery. Effective preventive interventions were active management strategies to promote uterine contractions in the third stage of labor; especially prophylactic uterotonics, nipple stimulation for induction of labor, breast feeding after the delivery of baby.
Conclusions
PPH is no longer unusual in Japan. It appears that some PPH cases are preventable by risk screening and preventive interventions. Based on the results of this literature review we should develop PPH prevention guidelines for midwives.
