A clinical study on management of major primary postpartum haemorrhage at tertiary care centre

Arvindar; Sangeeta Sen; Khushi

doi:10.18203/2320-1770.ijrcog20232284

Authors

Arvindar Department of Obstetrics and Gynecology, RNT Medical College, Udaipur, Rajasthan, India
Sangeeta Sen Department of Obstetrics and Gynecology, RNT Medical College, Udaipur, Rajasthan, India
Khushi Bachelor of Medicine and Bachelor of Surgery, Geetanjali Medical College, Udaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20232284

Keywords:

Oxytocin use, Post partum haemorrhage, Uterine atony

Abstract

Background: Postpartum Haemorrhage remains one of the leading causes of maternal morbidity and mortality worldwide. It is estimated that about one quarter to one half of preventable maternal deaths are because of haemorrhage. It is defined by the royal college of obstetrician and gynaecologist as blood loss from the genital tract within the first 24 hours after birth of at least 500ml (minor) and at least 1000ml (major) causes of post-partum haemorrhage (PPH) are commonly ascribed to the four Ts (tone, trauma, tissue, 4 thrombin).

Methods: This study aimed to assess the clinical practices used by our hospital in managing major PPH. Observational study of the management of PPH over a period of 2 months from March 2023 to April 2023 was carried out. Criteria examined: history of previous PPH causes of PPH, use of oxytocin in the first stage for more than 6 hours. Role of blood transfusion, presence of senior faculty, and type of uterotonics used.

Results: There were 50 patients diagnosed with major PPH among which 26 had caesarean delivery. Two major risk factors were analysed, one was Use of oxytocin in first stage for more than 6 hours and history of previous PPH. Uterine atony was commonest cause in 64% of cases.

Conclusions: Uterine atony is responsible for most of cases. Early, aggressive, and coordinated intervention by health care professionals is critical in minimizing blood loss to ensure optimal clinical outcomes in management of women with major PPH.

Metrics

Metrics Loading ...

References

Oyelese Y, Ananth CV. Postpartum haemorrhage: epidemiology, risk factors, and causes. Clin Obstet Gynecol. 2010;53(1):147-56.

Jena BH, Biks GA, Gete YK, Gelaye KA. Association of primary postpartum haemorrhage with inter-pregnancy interval in urban South Ethiopia: A matched nested case-control study. PLOS ONE. 2022;17(7):e0271216.

Tondge G, Burande A, A retrospective study of cases of postpartum haemorrhage at tertiary health care center. Indian J Obstet Gynecol Res. 2018;5(3):322-6.

Drife JO. Maternal ‘near miss’ reports? BMJ. 1993;307(6912):1087-8.

Baskett T, Sternadel J. Maternal intensive care and near-miss mortality in obstetrics. Br J Obstet Gynaecol. 1998;105(9):981-4.

Baskett TF, O’ Connell CM. Severe obstetrics maternal morbidity: 15 year population-based study. J Obstet Gynaecol. 2005;25(1):7-9.

Butwick AJ, Goodnough LT. Transfusion and coagulation management in major obstetric hemorrhage. Curr Opi Anaesthesiol. 2015;28(3):275.

Evensen A, Anderson J. Chapter J. Postpartum haemorrhage: third stage pregnancy. In: Leeman L, Quinlan J, Dresang LT, eds. Advanced Life Support in Obstetrics: Provider Syllabus. 5th ed. Leawood, Kan.: American Academy of Family Physicians; 2014.

Nyfløt LT, Sandven I, Stray-Pedersen B, Pettersen S, Al-Zirqi I, Rosenberg M, et al. Risk factors for severe postpartum hemorrhage: a case-control study. BMC Preg Childb. 2017;17:1-9.

Tondge G, Burande A. A retrospective study of cases of postpartum hemorrhage at tertiary health care center. Ind J Obstet Gynecol Res. 2018;5(3):322-6.

Grotegut CA, Paglia MJ, Johnson LN, Thames B, James AH. Oxytocin exposure during labor among women with postpartum hemorrhage secondary to uterine atony. Am J Obstet Gynecol. 2011;204(1):56.e1-6.

Ashraf T. Postportum hemorrhage: an experience at sandeman civil hospital, Quetta. J Coll Physicians Surg Pak. 1997;8:68-71.

Sabrina D, Craigo MD, Peter S, Kapernick MD. Postpartum hemorrhage and abnormal puerperium. Current Obstetrics and Gynecology logic diagram.6th ed. London: Appleton and Lange; 1987:574–82.

Japaraj RP, Raman S. Segstaken- Blakemore tube to control massive postpartum hemorrhage. Med J Malaysia. 2003;58(4):604-7.

Rizvi F, Mackey R, Barrett T, Mckenna P, Geary M. Successful reduction of massive postpartum hemorrhage by use of guidelines and staff education. BJOG. 2004;111(5):495-8.

Bazirete O, Nzayirambaho M, Umubyeyi A, Karangwa I, Evans M. Risk factors for postpartum haemorrhage in the Northern Province of Rwanda: A case control study. PloS one. 2022;17(2):e0263731.

Bernitz S, Betran AP, Gunnes N, Zhang J, Blix E, Øian P, et al. Association of oxytocin augmentation and duration of labour with postpartum haemorrhage: A cohort study of nulliparous women. Midwifery. 2023;123:103705.

Belghiti J, Kayem G, Dupont C, Rudigoz RC, Bouvier-Colle MH, Deneux-Tharaux C. Oxytocin during labour and risk of severe postpartum haemorrhage: a population-based, cohort-nested case-control study. BMJ Open. 2011;1(2):e000514.