Incidence and Risk Factors of Severe Obstetric Hemorrhage

Severe obstetric hemorrhage is the most feared obstetric emergency that can occur to any woman at childbirth. If unattended, the hemorrhage can kill even a healthy woman within two hours 1, 2. The Hemorrhage accounts for nearly one-quarter of all maternal deaths, and for almost half of all postpartum deaths in low-income countries 2–4. Recent studies in high resource settings 5 including Canada 6, the USA 7, Australia 8, and the UK 9 indicate an unexpected and unexplained increase in obstetric hemorrhage over the last 10 years. Although maternal deaths are extremely rare in high resource settings, the morbidity associated with a severe hemorrhage is still a major problem 9–13. Many more women survive but suffer serious illness as a result, not only from the effects of acute hypoperfusion and anemia, but also from the interventions that a severe hemorrhage may necessitate 14–16. Severe obstetric hemorrhage is, however, the most preventable complication. Nonetheless, suboptimal obstetric care was identified in more than half the deaths due to hemorrhage 17, 18. It is therefore suggested as a complementary indicator for the assessment of the quality of obstetric care 19, 20. The aim of this article is to review the incidence, causes, and risk factors of severe obstetric hemorrhage.

Abstract

Keywords

severe obstetric hemorrhage, risk factors, causes, coagulopathy, uterine atony