Key causal factors of postpartum Hamman's syn-drome

Abstract

This study evaluated factors associated with postpartum Hamman's syndrome using an integrated DEMATEL and neutrosophic logic analysis to model causal relationships and determine their impact. Factor selection was based on a systematic literature review, identifying 10 clinically relevant variables. Eight obstetrics and pulmonology experts assessed interactions between these factors using neutrosophic linguistic scales, enabling management of inherent clinical data uncertainty. Results demonstrated that intense Valsalva maneuver and prolonged second stage of labor emerged as the most influential factors, functioning as central nodes in the interaction network. Primigravidity was identified as the primary causal factor, while cervical subcutaneous emphysema, fetal macrosomia, and epidural analgesia were characterized as effects rather than causes. Other factors including advanced maternal age and respiratory history showed lower prominence, suggesting a less direct role in syndrome development. The integration of DEMATEL with neutrosophy proved effective for analyzing complex medical problems by clearly differentiating between causes and effects. This approach could be extended to other obstetric complications, providing a valuable evidence-based clinical decision-making tool.