title: Severe postpartum hemorrhage from uterine atony: a multicentric study.
abstract: OBJECTIVE
  Postpartum hemorrhage (PPH) is an important cause of maternal mortality (MM) around the world. Seventy percent of the PPH corresponds to uterine atony. The objective of our study was to evaluate multicenter PPH cases during a 10-month period, and evaluate severe postpartum hemorrhage management.
  
  
  METHODS
  The study population is a cohort of vaginal delivery and cesarean section patients with severe postpartum hemorrhage secondary to uterine atony. The study was designed as a descriptive, prospective, longitudinal, and multicenter study, during 10 months in 13 teaching hospitals.
  
  
  RESULTS
  Total live births during the study period were 124,019 with 218 patients (0.17%) with severe postpartum hemorrhage (SPHH). Total maternal deaths were 8, for mortality rate of 3.6% and a MM rate of 6.45/100,000 live births (LB). Maternal deaths were associated with inadequate transfusion therapy.
  
  
  CONCLUSIONS
  In all patients with severe hemorrhage and subsequent hypovolemic shock, the most important therapy is intravascular volume resuscitation, to reduce the possibility of target organ damage and death. Similarly, the current proposals of transfusion therapy in severe or massive hemorrhage point to early transfusion of blood products and use of fresh frozen plasma, in addition to packed red blood cells, to prevent maternal deaths.
authors.affiliation: Critical Care Obstetrics Unit, Complejo Hospitalario, Caja de Seguro Social, Bella Vista, Panama City, Panama.
authors.forename: Carlos
authors.initials: C
authors.lastname: Montufar-Rueda
authors.affiliation: National Library of Medicine, Lister Hill Center, National Institute of Health, Bethesda, Maryland, USA.
authors.forename: Laritza
authors.initials: L
authors.lastname: Rodriguez
authors.affiliation: COMIN-FECASOG, 4a Avenida 14-14 Zona 14, Guatemala City, Guatemala.
authors.forename: José Douglas
authors.initials: JD
authors.lastname: Jarquin
authors.affiliation: Hospital Mexico, La Uruca, San Jose, Costa Rica.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Barboza
authors.affiliation: Hospital Escuela Suyapa, Boulevard Suyapa, Calle La Salud, Tegucigalpa, Honduras.
authors.forename: Maura Carolina
authors.initials: MC
authors.lastname: Bustillo
authors.affiliation: Hospital Escuela HEODRA, Avenida Poniente, Leon, Nicaragua.
authors.forename: Flor
authors.initials: F
authors.lastname: Marin
authors.affiliation: Hospital Nacional Especializado de Maternidad, 25 Avenida Norte y Final Calle Arce, San Salvador, El Salvador.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ortiz
authors.affiliation: Clinica Las Americas, 11 Avenida 11-30 Zona 1, Guatemala City, Guatemala.
authors.forename: Francisco
authors.initials: F
authors.lastname: Estrada
mesh_terms: D000293:Adolescent; D000328:Adult; D016913:Blood Component Transfusion / Q000379:methods; D002489:Central America; D002585:Cesarean Section; D015331:Cohort Studies; D036861:Delivery, Obstetric; D017707:Erythrocyte Transfusion / Q000379:methods; D005260:Female; D006801:Humans; D008026:Ligation / Q000379:methods; D008137:Longitudinal Studies; D008755:Methylergonovine / Q000627:therapeutic use; D010120:Oxytocics / Q000627:therapeutic use; D010121:Oxytocin / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D011247:Pregnancy; D011446:Prospective Studies; D011453:Prostaglandins / Q000627:therapeutic use; D012720:Severity of Illness Index; D012769:Shock / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D013536:Suture Techniques; D055988:Uterine Artery / Q000601:surgery; D055357:Uterine Artery Embolization / Q000379:methods; D058738:Uterine Balloon Tamponade; D014593:Uterine Inertia / Q000401:mortality / Q000628:therapy*; D055815:Young Adult
chemical_list: D010120:Oxytocics; D011453:Prostaglandins; D010121:Oxytocin; D008755:Methylergonovine