Primary post partum hemorrhage. An obstetric catastrophe: a review of 270 cases

ABSTRACT

To see the frequency, causes of Primary Postpartum Hemorrhage [PPH], and identify the management options and to apply them successfully for control of primary PPH. So as to reduce the maternal morbidity and mortality rate. Retrospective study. This study was conducted in Gynae Unit-IV, Bolan Medical Complex Hospital, Quetta from January 2011 to July 2012. The data was collected from the records of patients who were admitted as case of Primary PPH and developed PPH during the delivery / Cesarean section. The data was noted on predesigned Proforma which include, complete obstetrical history, abdominal and pelvic examination and relevant laboratory investigations. The maternal condition was assessed and managed according to Hospital protocol. All maternal complications were noted. The patients who were bleeding at the time of delivery due to non - obstetrical condition were excluded from study. A total 270 cases of PPH were diagnosed. Major causes of Primary PPH were uterine atony in 143 [53%] retained placenta, in 49 [18%] ruptured uterus in 43 [16%] cases. The risk factors for uterine atony were prolonged 1[st] and 2[nd] stage of labour, grand multipara and retained placental tissues. Patients were managed both medically and surgically. The major morbidities were anemia 32%, hypovolemic shock 26%, puerperal sepsis 15% and acute renal failure 5%. Primary PPH is an important cause of serious morbidity and one of the leading causes of maternal mortality in the developing and developed world. The majority of deaths are preventable by the active management of 3[rd] stage of labour followed by a logical management protocol