Postpartum hemorrhage: Could oxytocin be the cause? Results from a morbidity and mortality review to enhance quality, safety, and relevance of care

Abstract

Introduction: A sudden postpartum hemorrhage (PPH) increase has been subjectively observed during summer 2018 in our level-3 maternity, despite following all official recommendations for PPH care. This observation led us to conduct a morbi-mortality review to understand morbidity increase reasons.

Methods: We conducted a first retrospective comparative cohort study from 2017 to 2018 to compare PPH rates. We conducted a second comparative study to determine the factors that may have led to an increase in PPH. One of the initial hypotheses of increased PPH was related to the weakness of oxytocin, exposed to high outside temperatures. The eight-day delivery records were analyzed, as follow: the high-frequency period of PPH (EXPOSED), the batch replacement of oxytocin (NON EXPOSED), and the same period of the previous year (1 YEAR BEFORE). We studied all known PPH risk factors: preconception, pregnancy, childbirth, and human, climatic, or material organizational factors in this maternity.

Results: 322 women were included: 111, 92, and 119 in the EXPOSED, NON EXPOSED, and 1 YEAR BEFORE groups, respectively. Sociodemographic data of the 3 groups were not different. The rate of PPH in the EXPOSED was significantly higher than that of NON EXPOSED, and 1 YEAR BEFORE: 20.7 %, 7.6 %, and 5.8 %, respectively (p = 0.0077). In the multivariate analysis, the reduction in PPH (EXPOSED vs NON EXPOSED) after changing the oxytocin batch was significant (OR 0.38 [0.14-0.91], p = 0.039).

Conclusion: Changing oxytocin batches during this hot period reduced significantly the PPH rate and maternal morbidity in our experience.

Keywords: Morbidity; Morbidity and mortality conference; Oxytocin; Pharmacology; Postpartum hemorrhage.