Postpartum Hemorrhage: Causes and Outcome

Nasreen Fatima, Kaneez Kubra

Abstract

Objective

To find out the frequency and causes of postpartum hemorrhage (PPH) and maternal and fetal outcome in a tertiary care set up.

Study design

Cross sectional study.

Place & Duration of study

Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from July 2017 To June 2018.

Methodology

Patients with postpartum hemorrhage who either delivered at JPMC or outside (admitted through emergency with history of PPH) fulfilling the inclusion criteria were enrolled in the study after taking informed consent. Immediate appropriate management started according to the cause and information recorded on predesigned form. Patients with chronic illnesses like diabetes mellitus, chronic kidney disease, and bleeding disorders such as disseminated intravascular coagulation  and those who were anemic, excluded from the study. Data analyzed by using SPSS Version 19. Quantitative variables presented as mean ± SD and qualitative variable with frequency and percentages. P value = 0.05 was considered significant.

Results

A total of 140 patients were managed during the study period. Mean age of the patients was 29 ± 4.8 year (from 18-45 year). Majority of women 55% (n=77) belonged to 26-30 year age group; while 20% (n=28) cases were between 31-35 year of age. 67.9% (n=95) patients had 1-2 parity while 24.3% (n-34) had more than 4 parity. Retained placenta and retained placental products (RPP) were found in 70% (n=98) patients, genital tract trauma in 32.1% (n=45), morbidly adherent placenta (MAP) in 12.8% (n=18) and 10% (n=14) uterine atony, as causes of PPH. Of the total, 139 patients received transfusion of packed cells. Total duration of hospital stay was from 1-30  7.1±5.71 days. FIve (3.5%) patients developed DIC. Four (2.8%) patients had septicemia. Renal failure and maternal mortality did not occur.

Conclusions

PPH is still an important obstetric emergency with retained placenta and placental products being predominant causes. PPH remains a major contributor of maternal morbidity and mortality.

Key words: Postpartum hemorrhage, Maternal morbidity, Maternal mortality.