Clinical profile of maternal deaths due to postpartum haemorrhage
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20203303Keywords:
Maternal mortality ratio, Non pneumatic anti-shock garment, Obstetric hysterectomy, Postpartum haemorrhage, Shock index, Uterine balloon tamponadeAbstract
Background: Postpartum haemorrhage is one of the dreadful complications that occur during delivery. It is often un-anticipated and occurs suddenly and un-expectedly. It is responsible for 20 percent of maternal deaths in developing countries. These deaths are largely preventable. The objective of the study was to find out the clinical profile, associated co-morbid conditions and contributory factors and treatment modalities used in the management.
Methods: Retrospective observational study of maternal deaths due to postpartum haemorrhage (PPH) was carried out at tertiary care hospital. The data of maternal deaths for seven years from year 2013 to 2019 was reviewed, compiled and analyzed to draw conclusions.
Results: There were 18 maternal deaths (19%) due to PPH out of total 86 maternal deaths. The average age of the woman who died due to PPH was 24 years. Ninety five percent of the cases of PPH were due to atonic uterus. Seventy percent of the cases had reported in advanced stage of shock with average blood loss of more than two to three litres. Poor general condition due to delay in reaching to tertiary care hospital was predominant feature. Sixty percent women underwent obstetric hysterectomy. Massive blood transfusion was given in fifty percent cases. Severe pregnancy induced hypertension, severe anaemia and severe concealed accidental haemorrhage were common associated factors in sixty percent of maternal deaths.
Conclusions: Postpartum haemorrhage is still a common cause of maternal death. Early detection, prompt aggressive management, adequate blood replacement, use of uterine balloon tamponade and non-pneumatic anti-shock garment, timely transfer to higher centre and timely decision for surgical interventions can prevent maternal deaths.
References
Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066-74.
World Health Organization Library. WHO Recommendations for the prevention and treatment of postpartum haemorrhage. Geneva, Switzerland: World Health Organization Library; 2012.
Amy JJ. Severe postpartum haemorrhage: a rational approach. Natl Med J India. 1998;11:86-8.
Rao KA. Presidential address. The 44th all India obstetric and gynecological congress. J Obstet Gynecol India. 2001;51:25-8.
Abou Zahr C. Global burden of maternal death and disability. Br Med Bull. 2003;67:1-11.
American College of Obstetricians and Gynecologists. ACOG practice bulletin: Clinical management guidelines for obstetrician-gynecologists number 76, October 2006: postpartum hemorrhage. Obstet Gynecol. 2006;108:1039-47.
McCarthy J, Maine D. A framework for analyzing the determinants of maternal mortality. Stud Fam Plann. 1992;23:23-33.
Balachandram V. Maternal Mortaltiy in Kaduna, Nigeria Med J. 1995;5:366-70.
Bias JM, Eskes M, Pel M, Bonsel GJ, Bleker OP. Postpartum hamorrhage in Wulparous women: incidence and risk factors in low and high-risk women. Eur J Obstet Gynecol Reprod Bwl. 2004;115(2):166-72.
Magann EF, Evans S, Flutechnison M, Collins R, Lanneau G, Mirrison JL. Postpartum heamorhage after cesarean delivery: an analysis of risk factors. S Med J. 2005;98:618-5.
Tindell K, Garfinkel R, Abu‐Haydar E, Ahn R, Burke TF, Conn K, et al. Uterine balloon tamponade for the treatment of postpartum haemorrhage in resource-poor settings: a systematic review. BJOG. 2013;120:5-14.
Burke TF, Ahn R, Nelson BD, Hines R, Kamara J, Oguttu M, et al. A postpartum haemorrhage package with condom uterine balloon tamponade: a prospective multi-centre case series in Kenya, Sierra Leone, Senegal, and Nepal. BJOG. 2016;123:1532-40.
Pendleton AA, Natarajan A, Ahn R, Nelson BD, Eckardt MJ, Burke TF. Emergency hysterectomy for uncontrolled postpartum hemorrhage may be averted through uterine balloon tamponade in Kenya and Senegal. Int J Gynecol Obstet. 2016;133:124.
Pendleton AA, Natarajan A, Ahn R, Nelson BD, Eckardt MJ, Burke TF. A qualitative assessment of the impact of a uterine balloon tamponade package on decisions regarding the role of emergency hysterectomy in women with uncontrolled postpartum hemorrhage in Kenya and Senegal. BMJ Open. 2016;6:e010083.
Herrick T, Mvundura M, Burke TF, Abu-Haydar E. A low-cost uterine balloon tamponade for management of postpartum hemorrhage: modeling the potential impact on maternal mortality and morbidity in sub-Saharan Africa. BMC Preg Childbirth. 2017;17(1):374.
Mvundura M, Abu-Haydar E, Okoth E, Okoth E, Herrick T, Mukabi J, et al. Cost effectiveness of the uterine balloon tamponade to control severe post-partum hemorrhage in Kenya. Int J Gynaecol Obstet. 2017;137:185-91.
Burke T, Danso-Bamfo S, Cappetta A, Masaki C, Guha M, Oguttu M, et al. An ultra-low cost uterine balloon tamponade package saves lives among women with advanced shock from uncontrolled postpartum hemorrhage in low resource settings. Ann Global Health. 2017;1(83):97-8.
Brees C, Hensleigh PA, Miller S, Pelligra R. A non-inflatable anti-shock garment for obstetric hemorrhage. Int J Gynaecol Obstet. 2004;87:119-24.
Hensleigh PA. Anti-shock garment provides resuscitation and haemostasis for obstetric haemorrhage. BJOG. 2002;109:1377-84.
Miller S, Fathalla MM, Youssif MM, Turan J, Camlin C, Al-Hussaini TK, et al. A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Egypt. Int J Gynaecol Obstet. 2010;109:20-4.
Miller S, Hamza S, Bray E, Gipson R, Nada K, Fathalla MF, et al. First aid for obstetrical haemorrhage: the pilot study of the non-pneumatic anti-shock garment (NASG) in Egypt. BJOG. 2006;113:424-9.
Miller S, Ojengbede O, Turan JM, Morhason-Bello IO, Martin HB, Nsima D. A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Nigeria. Int J Gynaecol Obstet. 2009;107:121-5.
Turan J, Ojengbede O, Fathalla M, Mourad-Youssif M, Morhason-Bello IO, Nsima D, et al. Positive effects of the non-pneumatic anti-shock garment on delays in accessing care for postpartum and post-abortion hemorrhage in Egypt and Nigeria. J Womens Health). 2011;20:91-8.
Non-pneumatic Anti-shock Garment-Compendium of New and Emerging Technologies that Address Global Health Concerns. Geneva: World Health Organization; 2011. Available at: http://www.who.int/medical_devices/innovation/new_emerging_tech_30.pdf. Accessed on 12th April 2020.
Pileggi-Castro C, Nogueira-Pileggi V, Tunçalp Ö, Oladapo OT, Vogel JP, Souza JP. Non-pneumatic anti-shock garment for improving maternal survival following severe postpartum haemorrhage: a systematic review. Reprod Health. 2015;12:28.
Maknikar S, Nanda R, Miller S. NASG reduces mortality in Indian women with PPH. Int J Gynecol Obstet. 2012;119:S413.
Magwali T, Butrick E, Mambo V, Ayadi A, Lippman S, Bergel E. Non-pneumatic anti-shock garment (NASG) for obstetric hemorrhage: Haraze, zimbabwe. Int J Gynecol Obstet. 2010;119:S410.
Miller S, Bergel EF, El Ayadi AM, Gibbons L, Butrick EA, Magwali T, et al. Non-pneumatic anti-shock garment (NASG), a first-aid device to decrease maternal mortality from obstetric hemorrhage: a cluster randomized trial. Abdel-Aleem H, editor. PLoS One. 2013;8(10):e76477.
