Abstract

RISK FACTORS, CAUSES AND OUTCOME OF POSTPARTUM HEMORRHAGE IN SULAIMANIA MATERNITY TEACHING HOSPITAL

Dr. Almas Mohammed Jabbar*, Dr. Nrmeen Najat M. Twfeeq and Dr. Maysaa Abdalhussein Mohammed

ABSTRACT

Postpartum hemorrhage (PPH) is still one of the leading causes of maternal morbidity and mortality. Blood loss in excess of 500ml after vaginal delivery or 1000 after C/S in the first 24 hours, is defined as primary PPH, and secondary PPH when the loss occurs between 24hrs and 12 weeks post delivery. Significant blood loss can be well tolerated by most young healthy women, and an uncomplicated delivery often results in a blood loss of more than 500 ml without any compromise of mother's condition. Aim of study: To identify risk factors for early PPH and the outcome of such cases in Sulaimania maternity teaching hospital. Setting and duration: The data are collected in sulaimania maternity teaching hospital through a six month period from the first of September 2012 to the first of March 2013. Design: This is a cohort observational study. Methodology: During the study period 80 cases developed significant PPH in the 1st 24 hr of delivery, sixty of them were vaginal delivery and twenty were caesarean section. For each case full, detailed history and examination, the causes of their bleeding and the procedures used to control their bleeding, were all recorded and tabulated. Results: The prevalence of PPH was o.8% of total deliveries, 0.9% of total NVD, and 0.7% of total C/S during the study period. Uterine atony was the most common cause of PPH (88.8%), the risk factors that strongly associated with PPH were multiparity (66.3%), induced and augmented labor (63.8%). Epsiotomy (38.8%), retained placenta(31.3%), were moderately associated with PPH. C/S (25%), trauma to genital tract (20%), hypertensive disorders(20%), previous C/S delivery(19%) are also contributed to the development of PPH. AMTSL was a protective factor for PPH in this study Conclusion and recommendation: Every pregnant lady who attend the labor room is at risk of developing PPI1, so all the staff in labor room should be well trained, vigilant and prepared for such complication. Restrictive use of oxytocine during induction and augmentation of labor, restrictive epsiotomy with AMTSL are all preventive factors for developing PPH and it's complications. Periodic observation and uterine massaging for the mother in postpartum period is mandatory.

Keywords: Risk factors of PPH, uterine atony, etiology of PPH, estimates of blood loss, management of PPH.