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Problem-Based Research Paper

Athena Guzman

Delaware Technical Community College

Nursing Research NUR 340-201

Dr. Heacock

February 18, 2024

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Introduction

The purpose of my paper is to inform my readers about postpartum hemorrhage.

“Postpartum hemorrhage (PPH) remains a leading cause of maternal death worldwide, and it is

important to understand the relative contributions of different risk factors (Fukami et al, 2019).”

This is a big problem in relation to any nursing practice due to the number of women who go

into labor every day and who could potentially have this type of complication. Early

identification of risk factors could help prevent many complications from happening.

Statement of the Problem

The question I chose to conduct my research on is: does early identification of risk

factors decrease a patient’s potential for postpartum hemorrhage? This topic was important in my

opinion due to the overwhelming research I found that proved this to be a growing problem that

we face in the medical field. Women and children could benefit tremendously from research

showing what early detection of risk factors could do to decrease the risk of postpartum

hemorrhage. “The accurate assessment of blood loss, identification of risk factors and timely

recognition of postpartum hemorrhage remain major challenges in obstetrics (Andrikopoulou &

D’Alton, 2019).”

Literature Review

“The majority of maternal deaths associated with hemorrhage could be preventable

(Andrikopoulou & D’Alton).” It can be detrimental to patients if we can’t detect these early

warning signs to prevent PPH. Postpartum hemorrhage can be defined as the blood loss that

happens to be greater than 1000 mL. PPH can also result from hypovolemia that occurs within

the first 24 hours post-delivery. Some of the risk factors that were found consisted of fetal
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macrosomia, pregnancy-induced hypertension (HTN), severe vaginal or perineal lacerations, and

weight gain over 15 kg during their pregnancy (Fukami et al, 2019).

“Atonic bleeding is major factor of PPH. Risk factors include antepartum and intrapartum

conditions as including a history of PPH, multiple pregnancies, primigravida, grand multiparity,

older age, preterm births, genital tract injuries, non-use of oxytocin for PPH prophylaxis, labor

induction, cesarean delivery and intra-uterine fetal deaths (Fukami et al, 2019).” Information. Is

still needed to help prove causes for PPH as many do not have risk factors.

Many of the research that was conducted was able to be broken into subgroups: maternal,

pregnancy-related and fetal factors. “The incidence of PPH is 6-11% of births worldwide, with

estimated prevalence of 3% in the United States, with recent reports demonstrating further

increases in the rates of this serious complications (Sade et al, 2022).” Some of the findings to be

concerned with are respiratory distress, shock, DIC (disseminated intravascular coagulation),

acute renal failure, and pituitary necrosis.

There have been studies to show that a specific blood type has an association with a

patient’s bleeding status. “Coagulation disorders are recognized as underlying causes for PPH

(Ali-Saleh et al, 2019).” When a female finds out that she is pregnant blood work is completed at

the first visit, which could tell the provider a lot about the patient and her pregnancy. It is the

providers job to notify the patient about abnormalities found in the blood work and address the

situation accordingly. Their findings showed that the blood type O was the one that they found

evidence on for risk factors of PPH. These studies showed comparisons between all of the blood

types.

Analysis
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The methodologies that were primarily used were deciding which age group they wanted

to use, they decided on how many pregnancies the women were allowed to have to participate in

the study, they looked at their medical history, their past medical history played a part in the

decision, the years in which they delivered their babies, and any complications they had

unrelated to PPH. They received approval from the IRB prior to conducting their research. They

didn’t always get consent from these mothers prior to using their information.

They only used a certain number of women who delivered in their facility during the

specific time frame they studied. They compared data they previously used prior to the

conclusion to this study and used it to base their findings on. They studied the blood loss that the

women suffered and compared it to what the doctor said was the cause at the moment. Once they

identified the cause they worked hard to find the ways to control the bleeding. That would mean

increasing or starting any fluids, and potentially replacing the blood with a blood transfusion.

Recommendations

I believe that first and foremost we need to gain consent from the women whose

information we plan to use. Iit is not ethicaly correct for us to use the information without first

consulting with them to make sure they are okay with it. Many women are not in agreeaance

with that feeling that even though their name is being withhel and any patient specific details are

withheld, they still believe it to be an invasion of their privacy.

After obtaining permission, I would say we need deicde which type of labor we want to

use and keep them separate. I don’t think we should have so many exclusions due to prior

medical history. There have been women without any prior medical history that would signify a

potential risk for PPH, but yet it has still happened.

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It was found that O blood type had no associations with increased risk of PPH in the

study that was conducted. Patients need to be continuously monitored for signs and symptoms as

some of them may be masked and otherwise missed. “Continuous assessment of vital signs and

ongoing estimation of total blood loss is an important factor in ensuring safe care of the patient

with PPH (Wormer et al, 2023).”

Noticing lacerations or hematomas from birth trauma can cause significant blood loss that

can be lessened if corrected in a timely manner. Time is the most important factor in this

situation, next comes identifying PPH, the causes, and the proper way to correct the problem. I

think if once the patient comes into the hospital, we could speak to them and their families about

possibly participating in our study, having them sign their acknowledgement and then all the

bases would be covered.

Conclusion

The research that is still being conducted is showing a decrease in the number of women

who suffer from PPH. This decrease is due to the overwhelming research showing what is

causing the PPH, detecting it early, and preventing it from happening. Knowing this information

would help save many lives and keep it from happening again.
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References

Andrikopoulou, M., & D’Alton, M. E. (February 2019). Postpartum hemorrhage: early

identification challenges. ScienceDirect. Volume 43, Issue 1, pg 11-17.

https://doi.org/10.1053/j.semperi.2018.11.003

Fukami, T., Koga, H., Goto, M., Ando, M., Matsuoka, S., Tohyama, A., Yamamoto, H.,

Nakamura, S., Koyanagi, T., To, Y., Kondo, H., Eguchi, F., & Tsujioka, H. (January 9,

2019). Incidence and risk factors for postpartum hemorrhage among transvaginal

deliveries at a tertiary perinatal medical facility in Japan. PLoS One. Doi:

10.1371/journal.pone.0208873.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326562/#:~:text=Uterine%20atony

%20%20responsible%20for,timely%20interventions%20to%20prevent%20PPH

Sade, S., Weintraub, A.Y., Baumfeld, Y., Kluwgant, D., Yohay, D., Rotem, R., & Parient, G.

(November 2022). Trend Changes in the individual contribution of risk factors for

postpartum hemorrhage over more than two decades. Maternal & Child Health Journal.

Vol. 26 Issue 11, p 2228-2236. 9p. 1 Diagram, 5 Charts, 1 Graph. https://web-p-

ebscohost-com.libproxy.dtcc.edu/ehost/delivery?sid=2e714e1d-69bc-4f14-870b-

e2ab1bb212c9%40redisvid=8&returnURL=https%3a%2f%2fweb.p.ebschohost.com

%2fehost%efpdfviewer%2fpdfviewer%3fvid%3d7%26sid%3d2e714e1d-696c-4f14-

870b-e2ab1bb212c9%2540redis

Ali-Saleh, M., Lavie, O., & Abramov, Y. (April 4, 2019). Evaluation of blood type as a potential

risk factor for early postpartum hemorrhage. PLOSONE.

https://doi.org/10.1371/journal.pone.0214840
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Wormer, K.C., Jamil, R.T., & Bryant, S.B. (May 8, 2023). Acute Postpartum Hemorrhage. NCBI

Bookshelf. https://www.sciencedirect.com/science/article/abs/pii/S014600051830123X