Factores de riesgo relacionados a la hemorragia postparto en embarazadas con alteración de coagulación en el Hospital Universitario de Guayaquil durante el período mayo 2022 a mayo 2023.

Abstract

Introduction: Postpartum hemorrhage (PPH) is known as one of the five causes of maternal death in high- and low-resource countries, being a high risk of death in the last mentioned. The time of recognition, availability of resources and an appropriate response helps prevent death and the severe maternal morbidity that may occur. Characterized by a loss of >500 ml of blood in 24 hours; loss >150ml/min; loss of 50% volume in 20 minutes and/or decrease in hematocrit 10%. Among the causes that lead to the pathology we have: uterine atony, trauma/lacerations, retention of placental remains and coagulation disorders. Different authors highlight that the most common cause is uterine atony, being responsible for 50-70% of postpartum hemorrhages and 4% of maternal death. Coagulation disorders, which occur in 7% of cases, can be acquired or congenital. Objectives: Compare the risk factors related to postpartum hemorrhage in pregnant women with coagulation disorders at the University Hospital during the period May 2022 to May 203. Methodology: The design of the research work was descriptive, observational, retrospective, cross-sectional with several analytical variables. Results: Of the total of 121 patients diagnosed with coagulation disorders during pregnancy, we have a total of 52% in outpatient consultation and 48% in hospitalization. Among the incidences of cases presented in outpatient clinics, four most determining risk factors are observed: iron deficiency anemia (55.56%), perineal tear during childbirth (15.87%), postpartum hemorrhage (11. 11%), hypovolemic shock (6.35%). On the other hand, considering the incidence of cases presented in hospitalization, there are also four determining risk factors: postpartum coagulation defect (20.69%), immediate postpartum hemorrhages (18.97%), secondary or late postpartum hemorrhage (15 .52%), and hemorrhage in the third stage of labor (8.62%). Finally, among the risk factors presented at the University Hospital of Guayaquil we obtain a total of 23 risk factors, taking into account that seven risk factors have a greater incidence, being: iron deficiency anemia (28.39%), others immediate postpartum hemorrhages (11.03%), postpartum coagulation defect (9.92%), anemia complicating pregnancy, childbirth and the puerperium (11.03%), perineal tear (8.26%), hemorrhage secondary or late postpartum (7.44%), postpartum hemorrhage (6.61%), and hemorrhage of the third stage of labor (4.13%). Conclusions: From the database observed in the Outpatient Consultation and Hospitalization area of the University Hospital, the presence of 23 risk factors according to the ICD-10 coding is observed, and that there are seven risk factors with a higher incidence, these being : iron deficiency anemia (28.93%); postpartum coagulation defect (9.92%); other immediate postpartum hemorrhages (11.03%); anemia that complicates pregnancy, childbirth and the puerperium (11.03%); perineal tear during childbirth (8.26%); secondary or late postpartum hemorrhage (7.44%); postpartum hemorrhage (6.61%); hemorrhage of the third period of labor (4.13%), obtaining a total of 83.47% and the difference of other factors with 16.53%. When carrying out an analysis of the most prevalent risk factors vs. the age of the patients, it was concluded that there is no association between the age variable and factors observed in the result of Pearson's Chi square, its significance being 0.522, confirms the weakness of this association in the contingency coefficient in its value of 0.164.