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Category: Volume 05 Issue 10 October 2017
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Title: Risk Factors and Outcome of Women with Post Partum Hemorrhage

Author: Dr Chetana A Gopchade

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i10.205

Abstract

Background: Postpartum hemorrhage is defined as blood loss more than 500 ml following normal vaginal delivery and 1000 ml following cesarean section. It is associated with significant maternal morbidity and mortality in developing world. The risk factors associated with PPH include obesity, multiparity, fetal macrosomia, preeclampsia, polyhydramnios, retained placenta, uterine atony and instrumental deliveries. Unless managed aggressively PPH has all the potential to prove fatal. Appropriate resuscitative measures, blood transfusions and sometimes surgical interventions are required. With proper management the maternal mortality due to PPH can be lowered to a significant level.

Aims and Objectives: (1) To study the risk factors associated with postpartum hemorrhage.

(2) To study the outcome of women with postpartum hemorrhage.

Materials and Methods: This was a prospective study of 30 women with postpartum hemorrhage who were admitted in our hospital. Patients were included in the study on the basis of predefined inclusion criteria. Patient having any exclusion criteria were excluded from this study. The risk factors associated with postpartum hemorrhage and outcome of pregnant women having PPH were studied. The data was tabulated and analyzed using SPSS 16.0 version software.

Results: Out of 450 deliveries which have taken place in our hospital during study period there were 30 patients who were diagnosed with PPH hence the incidence of PPH in our study was found to be 6.66 %. It was found 12 (40 %) women had BMI ≥30 while 18 (60 %) women had BMI less than 30. Amongst the studied cases 18 (60 %) were primipara, 10 (33.33%) were multipara and 2 (6.66 %) women were grand multipara. Multiparity, Large for gestational age babies, h/o PPH, Antepartum hemorrhage, preeclampsia, instrumental deliveries and LSCS were some of the factors associated with PPH. There was no maternal mortality amongst the studied cases. 2 (6.66%) patients had to be referred to higher centre for further management.

Conclusion:  Postpartum hemorrhage is one of the important causes of maternal morbidity and mortality in developing world. Identification and modification of known risk factors and proper management of PPH can significantly reduce maternal morbidity and mortality.

Keywords: Postpartum hemorrhage, Maternal morbidity and mortality, Risk factors, Outcome.

References

  1. Snelgrove JW. Postpartum Haemorrhage in the Developing World A Review of Clinical Management Strategies . McGill Journal of Medicine : MJM. 2009;12 (2):61.
  2. WHO Guidelines for the Management of Postpartum Haemorrhage and Retained Placenta. Geneva: World Health Organization; 2009.                              
  3. RCOG . 2009. RCOG Green-top Guideline No 52: prevention and management of postpartum haemorrhage.  updated 2011.
  4. Buzaglo N, Harlev A, Sergienko R, Sheiner E. Risk factors for early postpartum hemorrhage (PPH) in the first vaginal delivery, and obstetrical outcomes in subsequent pregnancy. J Matern Fetal Neonatal Med. 2015 May;28(8):932-7.
  5. Nyfløt LT, Sandven I, Stray-Pedersen B, et al. Risk factors for severe postpartum hemorrhage: a case-control study. BMC Pregnancy and Childbirth. 2017;17:17. 
  6. Kerr R, Eckert LO, Winikoff B, et al. Postpartum haemorrhage: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine. 2016;34(49):6102-6109. 
  7. Kramer MS, Dahhou M, Vallerand D, Liston R, Joseph KS. Risk factors for postpartum hemorrhage: can we explain the recent temporal increase? J Obstet Gynaecol Can. 2011 Aug;33(8):810-819. 
  8. Driessen M, Bouvier-Colle M-H, Dupont C, Khoshnood B, Rudigoz R-C, Deneux-Tharaux C. Postpartum hemorrhage resulting from uterine atony after vaginal delivery: factors associated with severity. Obstetrics and Gynecology. 2011;117(1):21-31. 
  9. Bain ES, Middleton PF, Crowther CA. Maternal adverse effects of different antenatal magnesium sulphate regimens for improving maternal and infant outcomes: a systematic review. BMC Pregnancy and Childbirth. 2013;13:195. 
  10. Varatharajan L, Chandraharan E, Sutton J, Lowe V, Arulkumaran S. Outcome of the management of massive postpartum hemorrhage using the algorithm "HEMOSTASIS". Int J Gynaecol Obstet. 2011 May;113(2):152-4.
  11. Ford JB, Patterson JA, Seeho SKM, Roberts CL. Trends and outcomes of postpartum haemorrhage, 2003-2011. BMC Pregnancy and Childbirth. 2015;15:334. 
  12. Snelgrove JW. Postpartum Haemorrhage in the Developing World A Review of Clinical Management Strategies . McGill Journal of Medicine : MJM. 2009;12(2):61.
  13. Blomberg M. Maternal obesity and risk of postpartum hemorrhage. Obstet Gynecol. 2011 Sep;118(3):561-8.
  14. Jaleel R, Khan A. Post-partum haemorrhage--a risk factor analysis. Mymensingh  Med J. 2010 Apr;19(2):282-9.
  15. Alsammani MA, Ahmed SR. Grand Multiparity: Risk Factors and Outcome in a Tertiary Hospital: a Comparative Study. Materia Socio-Medica. 2015;27 (4):244-247. 
  16. Sosa CG, Althabe F, Belizán JM, Buekens P. Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population. Obstet Gynecol.  2009 Jun;113(6):1313-9.
  17. Edhi MM, Aslam HM, Naqvi Z, Hashmi H. “Post partum hemorrhage: causes and management.” BMC Research Notes. 2013;6:236. doi:10.1186/1756-0500-6-236.
  18. Holm C, Langhoff-Roos J, Petersen KB, Norgaard A, Diness BR. Severe postpartum haemorrhage and mode of delivery: a retrospective cohort study. BJOG. 2012 Apr;119(5):596-604.
  19. Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B. Prevalence and risk factors of severe obstetric haemorrhage. BJOG. 2008;115:1265–1272.
  20. Chhabra S, Sirohi R. Trends in maternal mortality due to haemorrhage: two decades of Indian rural observations. J Obstet Gynaecol. 2004 Jan;24(1):40-3.

Corresponding Author

Dr Chetana A Gopchade

Consultant Obstetrician and Gynecologist,

Amrutpath Maternity Hospital Nanded. (MS)- India