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Journal of Pregnancy
Volume 2013, Article ID 525914, 6 pages
Clinical Study

Severe Postpartum Hemorrhage from Uterine Atony: A Multicentric Study

1Critical Care Obstetrics Unit, Complejo Hospitalario, Caja de Seguro Social, Bella Vista, Panama City, Panama
2National Library of Medicine, Lister Hill Center, National Institute of Health, Bethesda, Maryland, USA
3COMIN-FECASOG, 4a Avenida 14-14 Zona 14, Guatemala City, Guatemala
4Hospital Mexico, La Uruca, San Jose, Costa Rica
5Hospital Escuela Suyapa, Boulevard Suyapa, Calle La Salud, Tegucigalpa, Honduras
6Hospital Escuela HEODRA, Avenida Poniente, Leon, Nicaragua
7Hospital Nacional Especializado de Maternidad, 25 Avenida Norte y Final Calle Arce, San Salvador, El Salvador
8Clinica Las Americas, 11 Avenida 11-30 Zona 1, Guatemala City, Guatemala

Received 9 July 2013; Revised 23 September 2013; Accepted 29 October 2013

Academic Editor: Vorapong Phupong

Copyright © 2013 Carlos Montufar-Rueda et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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. Study Design. 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.