Atonic uterus; risk factors and management as a cause of primary postpartum hemorrhage

ABSTRACT

This study was designed to determine the frequency of uterine atony in cases of primary postpartum hemorrhage [PPH] and to point out risk factors for it and observe different ways of management for control of atonic primary [PPH]. Prospective cross sectional study. This prospective cross sectional study was conducted in Obstetrics and Gynecology Department unit-I, Bolan Medical Complex Hospital Quetta from 1st January to 31st December 2002 [one year]. The study was conducted on 80 patients. The study included all the pregnant women either booked or non-booked, who gave the inform consent. The sampling technique was convenience non probability. The patients were admitted through out-patient department and emergency, irrespective of age, place and mode of delivery, developing atonic primary PPH within twenty four hours and diagnosed as a case of uterine atony. All the cases of primary PPH other than due to uterine atony were excluded. Complete history, general physical examination, abdominal examination and pelvic examination was done. All the data was analyzed by SPSS version 10. Total number of deliveries during study period was 1438. Total number of patients with PPH were 155 out of which, the cases with primary PPH were 139, contributing about 89.7%. The incidence of primary PPH was 9.6 %. Out of 139 patients, the leading cause of primary PPH was uterine atony, contributing to 57.6%. The incidence of atonic uterus was 5.6 %. The highest incidence of uterine atony [37.5%] was found in women aged 26-30 years, followed by [27.5%] women aged 21-25 years.The highest incidence of primary PPH due to uterine atony was found in para 5-8 [56.3%], 6.3 % were primigravidas, 8.7% in para 1-4 and 28.7% in patients having more than eight children. Simple management included inj. Syntometrine, Oxytocin, uterine massage controlled bleeding in 53.7% cases. Prostaglandins [PGF2-alpha and PGE2] were administered in 32 cases and successful in 22 [68.7%] cases. Uterine packing was done in 8 cases, out of it, in 5 patients bleeding controlled [62.5%]. Ligation of uterine arteries was performed in 5 cases, it proved successful in 4[80%] and hysterectomy was done in 7.5% cases. Uterine atony is a major cause of primary PPH and major threat to the life of women in reproductive age. Uterine atony is more common in grand multipara, young women and in home delivery. Major risk factor for atony are previous history of primary PPH, grand multiparity, baby weight > 3.5kg and prolonged labour