Study of causes and various modalities of management in postpartum hemorrhage at a tertiary care centre
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20243607Keywords:
Maternal mortality, Tertiary care, India, Postpartum haemorrhageAbstract
Background: Postpartum haemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, particularly in low and middle-income countries. This study aimed to evaluate the causes and management strategies of postpartum haemorrhage at a tertiary care centre in India.
Methods: This hospital-based case series study was conducted at S. Nijalingappa Medical College, Bagalkot, over 18 months from August 2022 to February 2024. The study included 35 cases diagnosed with postpartum haemorrhage, defined as blood loss ≥500 ml within 24 hours after vaginal birth or ≥1000 ml after caesarean delivery. Data was collected using a structured proforma through patient interviews and medical record reviews.
Results: Most postpartum haemorrhage cases (65.7%) occurred in women aged 20-30 years and in primiparas (65.7%). Uterine atony was the leading cause (68.6%), followed by genital trauma (31.4%). Medical management with misoprostol (94.3%) and oxytocin (91.4%) was most common, along with carboprost (74.2%). Mechanical management included uterine massage (68.6%) and bimanual compression (57.1%). Surgical interventions included uterine artery ligation (28.6%), B Lynch sutures (20%) and obstetric hysterectomy (11.4%). Most patients (71.4%) had extended hospital stays exceeding 5 days.
Conclusions: The findings emphasize the importance of having essential medications readily available and maintaining surgical expertise for managing severe cases. This study highlights the need for improved antenatal care, standardized management protocols, and early intervention strategies in similar healthcare settings.
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References
Say L, Chou D, Gemmill A. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):323-33.
Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22(6):999-1012.
World Health Organization (WHO). World Health Report 2005: make every mother and child count. WHO. 2005.
Ghana Statistical Service, (GSS), Ghana Health Service (GHS), and Macro International 2009. Ghana Maternal Health Survey. 2007; 37.
Pacagnella RC, Souza JP, Durocher J. A systematic review of the relationship between blood loss and clinical signs. PLoS One. 2013;8(6):37-9.
Anderson JM, Etches D. Prevention and management of postpartum hemorrhage. Am Fam Physician. 2007;75(6):875-82.
Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg. 2010;110(5):1368-73.
Oyelese Y, Ananth CV. Postpartum hemorrhage: epidemiology, risk factors, and causes. Clin Obstet Gynecol. 2010;53(1):147-56.
Kramer MS, Berg C, Abenhaim H. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol. 2013;209(5):449-97.
Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg. 2010;110(5):1368-73.
Nyflot 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 pregnancy and childbirth. 2017;17(1):1-9
Ahmadzia HK, Phillips JM, James AH, Rice MM, Amdur RL. Predicting peripartum blood transfusion in women undergoing cesarean delivery: a risk prediction model. PLoS ONE. 2018;13:208417.
Reale SC, Easter SR, Xu X, Bateman BT, Farber MK. Trends in postpartum hemorrhage in the United States from 2010 to 2014. Anesth Analg. 2020;130:119–22.
Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev. 2014;13(2):3249.
Sahu MT, Das V, Mittal S, Agarwal A, Sahu M. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome. Arch Gynecol Obstet. 2010;281(2):215-20.
