**4. Results**

There are four steps to this research result as follows:

*In Step 1*, reviewed research results of risk factors for PPH via vaginal deliveries: systematic review and meta-analysis (**Table 1**) [29].



#### **Table 1.**

*Med calc version 18***.***6 was used to analyze risk factors for PPH during vaginal deliveries.*


**Figure 1.**

*Form for recording risk scores to predict postpartum hemorrhage (PPH) of blood loss over 300 ml after vaginal delivery. Source: approved by I-Tuporn, et al. [31].*

*Cases of Postpartum Hemorrhage and Hysterectomy in Thailand's Northern and Northeastern… DOI: http://dx.doi.org/10.5772/intechopen.102948*


*Source: Approved by Nutravong et al. [35], on An Appropriate Assessment of PPH by using a Risk Score Tool for prediction at Sakon Nakhon, Hospital, Thailand oral presentation in the International Webinar on Primary Healthcare and Medicare held during November 08–09, 2021/Vienna Austria.*

#### **Table 2.**

*Review of risk score at the different levels of blood loss from 250 ml. to 500 ml. in 1001 cases who underwent vaginal delivery at Sakhon Nakhon hospital, Thailand, during June 2018 to December 2019.*

*The ROC curve's performance at different levels of blood loss at over (a) 250 mL, (b) 275 mL, (c) 300 mL, and (d) 500 mL of a risk score for PPH prediction from 1001 cases after delivery at Sakon Nakhon hospital, Thailand from July 2018 to December 2019.*


**Table 3.** *Statistics on PPH, PPH-related hysterectomy, and maternal deaths were collected in Thailand's Chiang Rai Province. Chiang Rai regional hospital, Sakon Nakhon Province.* *Cases of Postpartum Hemorrhage and Hysterectomy in Thailand's Northern and Northeastern… DOI: http://dx.doi.org/10.5772/intechopen.102948*

This study was analyzed and identified risk factors for PPH via vaginal deliveries from 20 articles from 2005 to 2017 in Thailand and globally, using MedCalc version 18.2.1 and version 18.6 [30].

The results showed that 21 factors, including eight high-risk factors for PPH (odds ratio > 2.0) include antepartum hemoglobin ≤10 g/dL, coagulopathy, prior PPH, fibroid, placenta previa, placenta accrete, multiple pregnancy, and gestational hypertensive disorder. Six moderate risk factors for PPH (odds ratio > 1.5–2.0) include nulliparous status, large gestational age, placenta abruption, chorioamnionitis, induction, and augmentation of labor. Seven low-risk factors for PPH (odds ratio > 1.0–1.5) include maternal age < 20 years old and ≥ 35 years old, BMI level, primiparous, gestational age ≥ 42 weeks, gestational diabetes mellitus, and having received analgesic drugs.

*In Step 2*, Chiang Rai Regional Hospital reviewed the research findings of a risk scoring system for predicting postpartum blood loss greater than 300 mL (**Figure 1**) [31].

The results showed that the eight predictors of I-Tuporn et al. [31] (**Figure 1**) from the cause of PPH (4 T's and 7 steps of the clinical prediction model of Steyerberg) [32, 33] and by comparison with the standard monogram of Biguzzi [34], Sittipan [28], and Suta [27] could predict postpartum blood loss over 300 ml at Chiang Rai Regional Hospital with a sensitivity of 80.7%, a specificity of 60.8%, and the ROC curve equal to 0.71 at the optional cut-off score of four marks or above (see **Figure 1**) [31].

*In Step 3*, we reviewed research results for an appropriate assessment of PPH by. using a risk score tool for prediction at Sakon Nakhon Hospital, Thailand (**Table 2**) [35].

It found that the eight predictors of I-Tuporn et al. [31] (**Figure 1**) can be used to predict early PPH in Sakon Nakhon Hospital since blood loss is 250 ml and over with a sensitivity of 57.33%, a specificity of 61.95%, and a ROC curve equal to 0.62 (**Table 2** and **Figure 2**).

*In Step 4*, We reported the number of maternal deaths and PPH-related hysterectomy at Chiang Rai Regional Hospital and Sakon Nakhon province during 2019–2020.

The results of one-year follow-up showed the incidence of Chiang Rai Regional Hospital.

The number of cases of PPH-related hysterectomy decreased from 4.61% to 3.81% from 2019 to 2020 report of. It had no cases of PPH-related hysterectomy but had reported no maternal death per 100,000 infant live births, 36.60 and 37.36 respectively.

In Sakon Nakhon province, the incidence of PPH decreased from 1.39 to 1.10%, but there was no report of PPH-related hysterectomy. The maternal death rate decreased from 27.84 to 15.12 per 100,000 live births, from 2018 to 2019 (**Table 3**).
