audit of primary postpartum hemorrhage

ABSTRACT

The purpose of this study is to determine the causes of PPH, its risk factors, and treatment measures adopted. This prospective study was carried out in. the Department of obstetrics and gynaecology, Peoples Medical Collage Hospital Nawabshah from January 2009 to December 2009. Treatment measures including medical, surgical and blood transfusion were evaluated. A total of 165 cases of primary PPH were managed in one year. Uterine atony was identified major cause 128 [77.5%], traumatic causes of genital tract were 37 [22.4%], socioeconomic status was poor in 110 [66%] and lower middle class in 41 [24%]. Most of the patients 86 [52.1%] were delivered by traditional birth attendant, lady health visitors 36 [21.8%] and qualified medical doctors 29 [17.5%]. Blood pressure was unrecordable in 43 [26.0%], systolic B.P was below 80 mm in 55 [33.3%], systolic B.P above 100 mm in 67 [40.6%], hemoglobin [Hb%] level were b/w 8-10 gm% in 89 [53.93%], and less than 8 gm% in 76 [46.06%]. Blood transfusion was done in all cases. Uterine massage was done in 45 [27.27%]. Minor surgical procedures were performed in 57 [34.5], manual removal of placenta in 8 [4.8%], compression suture were applied in 2 [1.2%], hysterectomy in 20 [12.12%], and repair of uterus in 5 [3%]. Out of 62 cases who developed complications, 35 [21.21%] developed anemia, acute renal failure in 10 [6.06%], and disseminated intravascular coagulation in 3 [1.81%], maternal deaths due to irreversible shock and renal failure were in 10 [6.06%]. Maternal mortality during year 2009 due to PPH was 10 [29.41%]. PPH is a preventable problem. Maternal mortality and morbidity resulting from it can be reduced by identifying the risk factors, early referral, proper assessment and treatment of the cause. Conservative procedures should be considered prior to undertaken hysterectomy, and hysterectomy should be performed as the last option