DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20190310

Uterine atony risk factor after vaginal delivery in a tertiary hospital in Antananarivo, Madagascar

Tanjona A. Ratsiatosika, Randriamahavonjy Romuald, Rainibarijaona A. Lantonirina, Housni I. A., Rakotonirina A. Martial, Said Ismael Mhoudine, Rakotonirina Ando-Miora, Andrianampanalinarivo H. Rakotovao

Abstract


Background: Postpartum hemorrhage is the leading cause of maternal death in developing countries. Uterine atony is the cause in 80% of cases. Through this study, we want to determine risk factors for uterine atony after vaginal delivery route with oxytocin-mediated delivery.

Methods: This is a retrospective case-control study ranging from January 1st 2017 to June 31st 2018 at the Befelatanana University Hospital Centre of Gynecology-Obstetrics. The cases consisted of patients who had spontaneous vaginal delivery in the centre and had uterine atony. Authors studied maternal, obstetrical, neonatal parameters. Authors used the R software for the statistical analysis of the results.

Results: We found 40 cases of uterine atony out of 5421 deliveries with a prevalence of 0,73%. The average age was 27.73 years old±6.46 years old (p=0.113). The average parity was 2.67±1.62 (p=0.22). The total duration of labor was 6.88±2.95 hours (p=0.0187). The average duration of rupture of the membrane was 5.80±11.90 hours (0.003376). We found as risk factor of uterine atony the increase in oxytocin infusion rate during labor (OR=18.67, 95% CI 2.21-157.57), the artificial rupture of membranes (OR=5, 27, 95% CI 2.11-13.19), artificial induction of labor (OR=7.08, 95% CI 2.06-24.28) and labor over six hours (OR=2.53, 95% CI) % 1.18-5.47). In univariate analysis, premature delivery and a hypotrophic fetus were a factor risk of uterine atony (OR=3.07, 95% CI 1.27-7.44 and OR=3.43 95% CI 1.48-8.09 respectively) but this risk is not statistically significant in multivariate analysis with logistic regression (OR=1.27, 95% CI 0.40-3.84 and OR=2.19 95% CI 0.77-6.22). The main treatment was uterotonic drug use (72.5%). Authors identified seven cases of haemostasis hysterectomy and two cases of maternal death.

Conclusions: Present study confirms risk factors for uterine atony already known as prolonged labor and increased oxytocic infusion rate. Unrecognized factors have been identified as a risk factor for uterine atony such as the duration of rupture of the membranes and artificial rupture of the membranes. A minimal inflammation hypothesis that reduces susceptibility to oxytocin may explain this association. Knowing these factors would reduce the occurrence of uterine atony to reduce maternal mortality.


Keywords


Emergency peripartum hysterectomy, Oxytocic therapy, Postpartum hemorrhage, Risk factor, Uterine atony

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References


Deneux TC, Bonnet MP, Tort J. Epidemiology of postpartum haemorrhage. J Gyneco Obstet Biol Reprod. 2014;43(10):936-50

Cameron MJ and Robson SC, “Vital statistics: an overview,” in A Textbook of Postpartum Hemorrhage. A Comprehensive Guide to Evaluation, Management and Surgical intervention, C.B-Lynch, L. G. Keith, A. B. Lalonde, and M. Karoshi, Eds., Sapiens Publishing, 1st ed. 2006:17-34.

American College of Obstetricians and Gynecologists. ACOG practice bulletin; clinical management guidelines for Obstetrician Gynecologists postpartum hemorrhage. Obstet Gynecol. 2006;108(76):1039-47.

Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg 2010;110(5):1368-73

Panda B, Laifer S, Stiller R, Kleinman G. Primary atony of the lower uterine segment as a distinct cause of early postpartum haemorrhage: A case series and management Recommendations. J Obstet Gynaecol. 2009;29(7):628-32.

Tanjona a , Romuald R, Mahefa R, Housni IA, Martial RA, Mahenina RJ, et al. Emergency peripartum hysterectomy in a tertiary hospital in Antananarivo, Madagascar. Int J Reprod Contracept Obstet Gynecol. 2018;7(11):4752-7.

Breathnach F, BreathGeary M. Uterine Atony: Definition, Prevention, Nonsurgical Management, and Uterine Tamponade. Semin Perinatol.2008; 33(2):82-8

Wetta LA, Szychowski JM, Seals S, Mancuso MS, Biggio JR, Tita AT. Risk factors for uterine atony/postpartum hemorrhage requiring treatment after vaginal delivery. Am J Obstet Gynecol 2013;209(1):51-e1.

Montufar-Rueda C, Rodriguez L, JArquin JD, Barboza A, Bustillo MC, Marin et al. Severe Postpartum Hemorrhage from Uterine Atony:A Multicentric Study. J Pregnancy. 2013;1-6.

Feerasta SH, Motei A, Motiwala S, Zuberi NF. Uterine atony at a tertiary care hospital in Pakistan: A risk factor analysis. J Pak Med Assoc. 2000;50(4):132-6.

Grotegut C, Gilner J, Brancazio L, James A, Swamy G. 140: The maximal oxytocin infusion rate in labor is associated with uterine atony. Am J Obstet Gynecol. 2015;212(1):S86.

Butwick AJ, Carvalho B, El-Sayed. Risk factors for obstetric morbidity in patients with uterine atony undergoing Caesarean delivery. Br J Aneaesth. 2014 ;113(4):661-8.

Driessen M, Bouvier-Colle MH, Dupont C, Khoshnood B, Rudigoz RC, Deneux T et al. Postpartum Hemorrhage Resulting From Uterine Atony After Vaginal Delivery. Factors Associated With Severity. Obstet Gynecol. 2011;117(1):21-31

Zackler A, Flood P, Dajao R, Maramara L, Goetzl L. Suspected Chorioamnionitis and Myometrial Contractility: Mechanisms for Increased Risk of Cesarean Delivery and Postpartum Hemorrhage. Reproduct Sci. 2018;20(10):1-6.

Rauk PN, Friebe-Hoffman U. Interleukin-1b down regulates the oxytocin receptor in cultured uterine smooth muscle cells. Am J Reprod Immunol. 2000;43(2):83-9.

Zingg HH, Laporte SA. The oxytocin receptor. Trends Endocrinol Metab.2003;14(5):222-7.

Oakley RH, Laporte SA, Holt JA, Barak LS, Caron MG. Molecular determinants underlying the formation of stable intracellular G protein coupled receptor-beta-arrestin complexes after receptor endocytosis*. J Biol Chem. 2001;276(22):19452-60

Balki M, Cristian AL, Kingdom J, Carvalho JC. Oxytocin pretreatment of pregnant rat myometrium reduces the efficacy of oxytocin but not of ergonovine maleate or prostaglandin F 2 alpha. Reprod Sci. 2010;17(3):269-77.

Grotegut CA, Paglia MJ, Johnson LNC, Thames B, James H. Oxytocin exposure during labor among women with postpartum hemorrhage secondary to uterine atony. Am J Obstet Gynecol. 2011;204(1):56-e1.

Loscul C, Chantry AA, Caubit L, Deneux-Tharaux, Goffinet F, Le Ray. Association entre les intervalles d’augmentation de l’ocytocine pendant le travail et le risque d’hémorragie du postpartum. J Gynecol Obstet. 2016;45(7):708-15.

Chevillot M, Marret H, Jonville-Bera AP, Perrotin F, Arbeille P, Body G et al. Risk factors for haemorrhage from delivery (≥ 1,000 milliliters) due to uterine atony: case-control study on 300 files per week. J Gynecol, Obstet, Biol Reproduct. 2004;33(4):346-7.

Tarrab S, Marpeau L. Against routine induction "at" 41 weeks of amenorrhea and zero days. Gynecol Obstet Fertil. 2008;10(36):1058-61.

Cekmez Y, Ozkaya E, Ôcal FD, Küçüközkan T. Experience with different techniques for the management of postpartum hemorrhage due to uterine atony: compression sutures, artery ligation and Bakri balloon. Ir J Med Sci. 2015;184(2):399-402.




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