AN AUDIT OF PRIMARY POST PARTUM HAEMORRHAGE
AbstractBackground: Postpartum haemorrhage (PPH) is one of the leading causes of maternal morbidity andmortality .Its causes & risk factors are important for its prevention and management. Poor, unhealthy, highparity women delivering away from health facility are usual victims. The purpose of this study is todetermine causes of PPH, risk factors, preventable factors and to assess treatment measures adopted.Methods: This retrospective study is carried out in Gynaecology 'B' unit of Ayub Teaching HospitalAbbottabad. All patients admitted with PPH or developed PPH within hospital from 1st Jan–31st Dec 2006are included. Exclusion criteria were patients with bleeding disorders and on anticoagulants. Records ofadmissions, deliveries, caesareans, major & minor procedures and history charts were thoroughlyevaluated for details. Details included age, parity, socioeconomic status, transportation facility, distancefrom hospital, onset of labours, birth attendant skilled/unskilled, evaluation of risk factors, duration oflabour and mode of delivery. Patient’s general health, anaemia, shock, abdominal and pelvic examinationand laboratory findings were also taken in to account. Treatment measures including medical, surgical,blood transfusions were evaluated. Results: The most important cause was uterine atony, 96 (70.5%) andtraumatic lesions of genital tract, 40 (29.4%). Factors causing uterine atony were augmented labour 20(20.9%), prolonged labour 21 (21.9%), retained placental tissues, 11 (12.5%), retained placenta, 11(11.4%) Couvelliar uterus, 10 (10.4%), placenta preavia, 8 (8.3%), placenta increta, 7 (7.3%),chorioamnionitis 5 (5.2%), and multiple pregnancy, 2 (2.1%). Risk factors, grand multiparity 70 (51.5%),antepartum haemorrhage 12 (8.9%), instrumental delivery 10(7.3%), previous PPH, 6 (4.5%),choreoamnionitis, 5 (3.6%), multiple pregnancy, 2 (1.5%), no risk factor, 21 (15.4%). Socioeconomicstatus was poor (75) & lower middle class (61). Induced labour, 33 (24.3%), augmented labour 62(45.5%).Uterotonics used for prophylaxis in 30 (22%), for treatment of PPH, 106 (78%). Patientsdelivered by traditional birth attendants 70 (51.4%), lady health workers 40 (29.4%) & doctors 26(19.2%).Uterine massage performed in 30 (22%), minor surgical procedures 33 (24.3%), manual removalof retained placenta, 11 (8%), hysterectomy, 50 (36.7%), & compression sutures were applied in 3 (2.2%).Maternal deaths due to PPH were 6 (40%). Conclusions: PPH can be prevented by avoiding unnecessaryinductions/augmentations of labour, risk factors assessment and active management of 3rd stage of labour.It needs critical judgment, early referral and early resuscitation by birth attendant. There is room fortemponade and compression sutures. Hysterectomy should be the last option.Keywords: Post Partum Haemorrhage, Uterine atony, Uterotonics, Compression sutures.
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