Introduction
Postpartum hemorrhage (PPH) is still one of the major issues pertaining to obstetrics causing maternal morbidity and mortality globally. Postpartum hemorrhage after induction arises when the uterus is incapable of contracting well which leads to excessive bleeding. Drugs such as artificial oxytocin may stimulate the uterus and so induce a high chance of postpartum hemorrhage. Prompt recognition and management such as uterine massage, medication, and going to surgical interventions are vital to avoid complications and for the mother’s welfare. This review evaluates eight studies that explore different aspects of PPH, particularly elective induction as a potential risk factor. The studies assess incidence, predictors, management, and outcome of PPH following induction of labor as compared to spontaneous onset. Based on a broad review, this paper looks into the current comprehension of PPH occurring in elective inductions, reveals areas of knowledge that remain unexplored, and provides guidance on future studies and clinical practice.
Comparison of Research Questions
The research questions across the studies differ slightly in focus but mostly they are about the prevalence, risk factors, and management of PPH among pregnant women mainly undergoing elective induction. Some of the studies particularly examine the incidence and complications of induction of labor (Kumar et al., 2021; Brun et al., 2019; Rafiq et al., 2023), while others evaluate the risk factors for PPH following cesarean delivery (Ashwal et al., 2022; Zewdu & Tantu, 2023). Li et al. (2021) and Gulbaz et al. (2019) assess the management approaches in post-partum hemorrhage. Basically, these questions cumulatively lead to a holistic view of PPH in the case of obstetric interventions.
Comparison of Sample Populations
The sample populations in the studies differ in size and composition. Some of the studies, for instance, Li et al. (2021), and Zewdu & Tantu (2023), with sample sizes greater than 30,000 and 700 women, respectively, provide adequate data. However, smaller studies like Rafiq et al. (2023) and Gulbaz et al. (2019) have sample sizes of around 250 and 20 respectively, which limits the generalizability of their findings. Further, the inclusion criteria in the studies differ, some focusing on specific populations, such as women undergoing cesarean delivery (Ashwal et al., 2022; Zewdu & Tantu, 2023) or induction of labor (Brun et al., 2019; Rafiq et al., 2023). Such variations in sample size and composition may, in turn, influence the validity and generalizability of the study findings.
Comparison of Limitations of the Study
Every study has its own set of limitations that may manipulate the result interpretation and their applicability to clinical practice. For instance, most studies used in this review rely on retrospective data that might introduce bias and limit establishing causality (Kumar et al., 2021; Brun et al., 2019; Liu et al., 2021; Ashwal et al., 2022; Delporte et al., 2019; Zewdu & Tantu, 2023; Gulbaz et al. (2019). Gulbaz et al. (2019) have a very small sample size limiting the statistical power and generalizability of the findings. In contradiction, some studies omitted having control over some confounding variables. Also, the generalizability of the results is limited by populations and settings studied in or on which the researches were conducted. The outlined restrictions call for bias-free extraction of knowledge while conducting research.
Conclusion and Recommendations for Further Research
In a nutshell, the reviewed studies offer useful perspectives on the epidemiology, predictors, and management of PPH in various clinical settings. Nonetheless, more work is still required to resolve the main issues. Moreover, large-scale prospective studies are essential to validate the findings and illustrate the causal links between labor induction and PPH. In addition, studies on the efficiency of preventive methods, like standardized induction protocols and uterotonic prescriptions are crucial in order to decrease PPH prevalence and severity. More research is equally required to examine the impact of the patient factors, the obstetric interventions, and the healthcare system characteristics on PPH outcomes. This will in turn aid in evidence-based practice and hence help in improving maternal health outcomes globally. In the end, a multi-disciplinary approach that requires the cooperation between obstetricians, midwives, nurses, and researchers is the most important in developing novel approaches and supporting successful interventions for the PPH curve.
References
Ashwal, E., Bergel Bson, R., Aviram, A., Hadar, E., Yogev, Y., & Hiersch, L. (2022). Risk factors for postpartum hemorrhage following cesarean delivery. The Journal of Maternal-Fetal & Neonatal Medicine, 35(18), 3626-3630. https://doi.org/10.1080/14767058.2020.1834533
Brun, R., Spoerri, E., Schäffer, L., Zimmermann, R., & Haslinger, C. (2019). Induction of labor and postpartum blood loss. BMC Pregnancy and Childbirth, 19, 1-7. https://doi.org/10.1186/s12884-019-2410-8
Delporte, V., Grabarz, A., Ramdane, N., Bodart, S., Debarge, V., Subtil, D., & Garabedian, C. (2019). Cesarean during labor: Is induction a risk factor for complications? Journal of Gynecology Obstetrics and Human Reproduction, 48(9), 757-761. https://doi.org/10.1016/j.jogoh.2019.08.008
Gulbaz, S., Zafar, S., & Rehman, S. (2019). Post Partum Hemorrhage; Risk Factors and Management among Women Presenting to a THQ Hospital. National Editorial Advisory Board, 30(7), 63. https://www.academia.edu/download/60773867/PCOS_and_infertility20191002-1417-w2p6m2.pdf#page=68
Kumar, B., Kumari, S., Hughes, S., & Savill, S. (2021). Prospective cohort study of induction of labor: Indications, outcome and postpartum hemorrhage. European Journal of Midwifery, 5. https://doi.org/10.18332%2Fejm%2F142782
Liu, C. N., Yu, F. B., Xu, Y. Z., Li, J. S., Guan, Z. H., Sun, M. N., … & Chen, D. J. (2021). Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study. BMC Pregnancy and Childbirth, 21(1), 1-8. https://doi.org/10.1186/s12884-021-03818-1
Rafiq, S., Ali, S., Bashir, H., Karim, S., Mateen, A., & Zia, S. (2023). Comparison of the frequency of postpartum hemorrhage in induced labour and spontaneous labour in pregnant women. The Professional Medical Journal, 30(10), 1264-1269. https://doi.org/10.29309/TPMJ/2023.30.10.7669
Zewdu, D., & Tantu, T. (2023). Incidence and predictors of severe postpartum hemorrhage after cesarean delivery in South Central Ethiopia: a retrospective cohort study. Scientific Reports, 13(1), 3635. https://doi.org/10.1038/s41598-023-30839-x
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