Analysis of maternal transport cases by postpartum hemorrhage

• Published in: Journal of Japan Society of Perinatal and Neonatal Medicine Vol. 56; no. 1; pp. 31 - 36
• Main Authors: Omura, Miho, Kasai, Yasuyo, Osato, Ayano, Akutagawa, kana, Tsumura, Shiho, Ide, Sanae, Hosokawa, Satsuki, Arima, Kaori, Watanabe, Michiko, Yamada, Manabu, Andoh, Kazumichi, Miyauchi, Akito
• Format: Journal Article
• Language: Japanese
• Published: Japan Society of Perinatal and Neonatal Medicine 2020
• Subjects: epidural analgesia; maternal emergency transport; perinatal tear; postpartum hemorrhage
• ISSN: 1348-964X; 2435-4996
• DOI: 10.34456/jjspnm.56.1_31

We targeted 57 cases of maternal transport to Japanese Red Cross Mecical Center by postpartum hemorrhage（PPH）with more than 1,000ml blood loss in 6 years from April 2011 until March 2017. In this study, we have performed a retrospective analysis of the mode of delivery, examinations, amount of bleeding, final diagnosis and treatment. In recent years, the number of postpartum transport with PPH has been increasing. One-third of these cases were due to atonic bleeding, another one-third of these cases were due to the injury of the birth canal. Epidural analgesia was performed in 50％ of PPH cases. In 43％ of atonic bleeding cases and 60％ of injury of the birth canal cases, epidural analgesia was also performed. In more than 70％ of injury of the birth canal cases with the history of vaginal delivery, epidural analgesia was performed. In 32 cases diagnosed with atonic hemorrhage before transport, 11 cases had another cause of bleeding. In 11 cases with different final diagnosis, 4 cases were the injury of the birth canal, 5 cases were retention of the placenta and 2 cases were amniotic fluid embolism. It is recommended that patients with massive puerperal hemorrhage who are judged to be difficult to treat at primary or secondary institutions should be transported to a higher medical institution promptly. On the other hand, in the facilities accepting maternal transport, the key of the mother’s lifesaving is to diagnose the accurate cause of the puerperal massive hemorrhage quickly, and to treat it in cooperation with another department.