Prediction of postpartum hemorrhage among by using the uterine artery vellosymmetry in patients with normal spontan vaginal patients

Objective: We aimed to investigate the effect of bilateral uterine artery Doppler flow velocimetry in the postpartum period to predict flow changes and to predict the risk of early postpartum hemorrhage (PPH) after birth. Our secondary purpose is; to assess the relationship of ultrasonographic findings such as myometrial thickness, endometrial features and uterine volume to PPH in the same patient group. Materials and Method: This prospective study was initiated by approval of the ethics committee of clinical research at Akdeniz University Medical Faculty. Doppler pulsatile index (PI), myometrial / endometrial thicknesses, and uterine volumes of bilateral uterine arteries were measured within 8 hours postpartum in 90 patients who had 30 weeks of gestation and delivered by normal vaginal delivery. Demographic characteristics, examination findings, amounts of bleeding, and laboratory data (at the time of initial admission and postpartum 24 hours) were recorded. The distribution of current hemoglobin changes (difference between hemoglobin at the time of admission and 24 hour hemoglobin values in the postpartum) in the population that constituted the patient group was determined and the fourth quartile (75 percentile) value was found to be 1.7 g / dl. According to this, when the hemoglobin change is ≥ 1.7 g / dl, it is accepted as a significant decrease of hemoglobin and later as the PPK criterion. The uterine artery Doppler PI (mean) values and significant hemoglobin decline were compared in the direction of these data. In addition, parameters that may have effects on significant hemoglobin decline and uterine artery Doppler PI (mean) during the study were statistically analyzed. Results: There was a significant correlation between the values of uterine artery Doppler PI (mean) and significant hemoglobin decrease (p = 0.003). Uterine artery Doppler ultrasonography time was later in patients with higher PI (mean) value (p = 0.039). Patients with significant hemoglobin decline had lower prenatal platelet counts (p = 0.004). When the Uterine artery Doppler PI (mean) value was selected as 0.84, the sensitivity of detecting hemoglobin decline was found to be 61% and specifity was 66%. Uterine artery Doppler PI was shown to increase the risk of significant hemoglobin decline independent of ultrasound time and pre-platelet count (p = 0.022). When the Uterine artery Doppler PI (mean) was > 0.84, the risk of bleeding decreased by 73.7 % (p = 0.046).Myometrial thickness measurements, uterine volume, and endometrium thickness were not different between patients with and without significant hemoglobin decline (p > 0.05). Discussion: Postpartum uterine artery Doppler evaluation revealed that early postpartum PPH risk could be predicted. In this regard, there is a need for large-scale prospective studies of uterine artery Doppler velocimetry in patients at different risk groups for PPH.