DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20161709

A study of risk factors of postpartum hemorrhage and indications for caesarean section

Bhavana G., Abhishek MV, Suneeta Mittal

Abstract


Background: To prevent post-partum hemorrhage the concept of active management of third stage of labour has been proposed which decreases the blood loss by 40-68%. The best preventive strategy is active management of the third stage of labour. The objective of the study was to study risk factors of postpartum hemorrhage and indications for caesarean section.

Methods: A hospital based cross sectional study was carried out among 100 women at term for a period of one year. Pregnant women who are at term i.e. at 38-39 weeks of gestation were included in the study. Detailed history, clinical examination and investigations were carried out.

Results: The mean pre pregnancy BMI in study group was 22.4±3.96. The majority of patients recruited were primiparous. Socio-demographic data shows that there was no statistical difference in place of residence, occupation and level of literacy between two groups. The prevalence of anemia among women at term was found to be 43%. The most common obstetric high risk factor was gestational diabetes mellitus in 10% followed by gestational hypertension in (6%). 71% of women underwent the emergency LSCS. The most common indication for LSCS was fetal distress in 29% of cases followed by mal-presentation in 12% of cases.

Conclusions: The prevalence of anemia among women at term was found to be 43%. The different medical high risk factors were human immunodeficiency virus positive (asymptomatic diagnosed during pregnancy), Hepatitis B antigen positive, cardiovascular risk, hypothyroidism, epilepsy observed in the groups. Other high risk factors included asthma, Crohns disease, and systemic sclerosis.


Keywords


Postpartum hemorrhage, Caesarean section, Term pregnancy

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References


Ronsmans C, Graham WJo Borghi, Oona Campbell, Veronique Filippi, Marge Koblinsky, Anne MillsJ: Maternal mortality: who, when, where, and why. Lancet. 2006;368(9542):1189-200.

Elbourne DR, Prendiville WJ, Carroli G, Wood J, McDonald S. Prophylactic use of oxytocin in the third stage of labour. Cochrane Database Syst Rev. 2001;(4):CD001808.

World Health Organization (WHO) Department of Reproductive Health and Research. Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF, and UNFPA. Geneva: WHO; 2004.

Wise A, Clark V. Challenges of major obstetric haemorrhage. Best Practice and Research Clinical Obstetrics and Gynaecology. 2010;24:353-65.

World Health Organization. The World Health Report 2005.

Kongnyuy EJ, Mlava G, Broek N van den. Facility-based maternal deathreview in three districts in the central region of Malawi: an analysis ofcauses and characteristics of maternal deaths. Womens Health Issues. 2009;19(1):14-20.

Khan KS, Wojdyla D. WHO analysis of causes of maternal death: a systematicreview. Lancet. 2006;367(9516):1066-74.

AbouZahr C: Global burden of maternal death and disability. Br MedBull. 2003;67:1-11.

Saving Mothers 2005-2007: Fourth Report on Confidential Enquiries into Maternal Deaths in South Africa. Available from: www.doh.gov.za/docs/reports/2011/saving1.pdf.

ICM and FIGO. Joint statement: management of the third stage of labour to prevent postpartum haemorrhage [Joint statement] 2003.

WHO. MPS Technical Update: Prevention of Postpartum Haemorrhage by Active Management of Third Stage of Labour. 2006.

Prendiville WJP, Elbourne D, McDonald SJ. Active versus expectant management in the third stage of labour. Cochrane Database of Systematic Reviews 2000;3.

Jackson KW Jr, Allbert JR, Schemmer GK, Elliot M, Humphrey A, Taylor J. A randomized controlled trial comparing oxytocin administration before and after placental delivery in the prevention of postpartum hemorrhage. Am J Obstet Gynecol. 2001;185:873-7.

Rizvi F, Mackey R, Barrett T, McKenna P, Geary M. Successful reduction of massive postpartum haemorrhage by use of guidelines and staff education. BJOG. 2004;111:495-8.

Active Management Of third stage of labour -prevention and treatment of post-partum haemorrhage - SOGC practice guideline no. 235 October 2009.

Gai MY, Wu LF, Su QF, Tatsumoto K. Clinical observation of blood lossreduced by tranexamic acid during and after caesarean section: a multicenter,randomized trial. Eur J Obstet Gynecol Reprod Biol. 2004;112:154-7.

Gungorduk K, Yildirm G, Asicioğlu O. Ark Efficacy of intravenous tranexamic acid in reducing blood loss after elective cesarean section: a prospective, randomized, double-blind, placebo-controlled study Am J Perinatol. 2011;28(3):233-40.

Sekhavat L, Tabatabaii A, Dalili M. Efficacy of tranexamic acid in reducing blood loss after cesarean section The Journal Of Maternal-Fetal And Neonatal Medicine. 2009;22(1):72-5.

Movafegh A, Eslamian L, Dorabadi A. Effect of intravenous tranexamic acid administration on blood loss during and after cesarean delivery International. Int J Gynaecol Obstet. 2011;115(3):224-6.

Gohel M, Patel P, Gupta A, Desai P. Efficacy of tranexamic acid in decreasing blood loss during and after cesarean section: A randomized case controlled prospective study. J Obstet Gynecol India. 2007;57(3):227-30.