Pattern of Clinical Presentation, Risk Factors and Maternal Outcome In Patients Presenting With Primary Postpartum Hemorrhage

Rubina Hafeez, Samina Rafiq, Shoiabunnisa, Mahjabeen Khokar, Sabahat Fatima,Tahmina Mahar

Abstract

Objective

To determine the frequency, risk factors, causes and maternal outcome in patients presenting with primary postpartum hemorrhage (PPH).

Study design

Cross sectional  study.

Place & Duration of study

Department of Obstetrics and Gynecology Unit II, Ghulam Muhammad Mahar Medical College & Hospital Sukkur Sindh Pakistan, from January 2020 to December 2022.

Methods

All pregnant women, above 24-weeks of gestation, who developed PPH within 24-hours of vaginal or abdominal delivery in our hospital and those who presented with the history of delivery at home or other healthcare facilities, were included in this study. Women on anticoagulant therapy were excluded. Data were collected on especially designed form. Data were entered into SPSS version 20 software.

Results

Total Number of births during the three years study period were 4627. The number of patients who developed primary PPH were 49 (1.05%). Majority of the patients (n=44 - 90%) were non booked. Most of the patients (n=25 – 51.0%) were in the age group of 26-35 years. Majority (80%) of women had vaginal delivery. Nine (18.3%) patients were received from outside. Grand multiparty was the commonest risk factor in 25 (51.5%) followed by prolonged labour in 6 (12.2%), placenta previa in 5 (10.2%) and abruptio placentae in 4 (8%) patients. Uterine atony was the commonest cause of PPH (n=37 - 75%) followed by cervical and perineal tears (n=8 - 16%). Medical management along-with uterine massage was the commonest management option used for uterine atony in 80% cases, followed by intra-uterine packing in 6 (12%), and peripartum hysterectomy in 4 ( 8%) women. Four women (8.1%) died in this series.

Conclusion

The frequency of PPH was 1.05%. Grand multiparty, prolonged labor and placenta previa were the common risk factors. Uterine atony was the commonest cause of primary PPH. Medical management along-with uterine massage was the commonest technique used to control hemorrhage.  

Key words

Postpartum hemorrhage, Grand multipara, Uterine atony, Peripartum hysterectomy, Retained placenta.