Abstract
Introduction: Obstetric haemorrhage still remains the leading cause of maternal mortality worldwide. The Confidential review of maternal deaths in Kerala from 2004-2009 has shown that obstetric haemorrhage tops the list and steps to improve obstetric standards have been introduced in Kerala since 2014.It has also emerged as the major cause of severe maternal morbidity.
Materials and Methods: This is a retrospective descriptive study conducted in a tertiary care centre in south Kerala to analyse the pattern of peripartum haemorrhage during the period from January to December 2016. Blood loss more than 500ml within a period of 24 hrs prior and after parturition irrespective of the mode of delivery was considered as peripartum haemorrhage. The cases were grouped into 4 according to the magnitude of transfusion.
Results: Of the 8520 births in the institution 140 cases had peripartum haemorrhage (1.64%). Cases with haemorrhage referred after parturition were 24. Cases which did not receive transfusion belonged to group 1(29.88%). Majority (48.78%) belonged to group 2 with transfusion of ≤ 2 PRC. Massive transfusion was received by 7.92%. The proportion of atonic postpartum haemorrhage was 70/164 (42.68%). Abruptio placenta accounted for 25% and placenta previa for 20.12 % of peripartum haemorrhage. Morbidly adherent placenta previa was the major contributor of massive haemorrhage and peripartum hysterectomy. A single maternal mortality due to haemorrhage was due to severe preeclampsia, HELLP, DIC
Conclusion: Atonic PPH remains the prime causeof peripartum haemorrhage. Morbidly adherent placenta previa in previous caesarean had become a major contributor of massive haemorrhage, massive transfusion, obstetric hysterectomy and maternal near miss.
Keywords: peripartum haemorrhage, massive transfusion, morbidly adherent placenta previa, obstetric hysterectomy, maternal near miss.
References
- Walfish M, Neuman A, Wlody D. Maternal haemorrhage. British Journal of Anaesthesia. 2009 Dec 1;103(suppl_1): i47-56.
- khan ks wojdyla D, Say L, Gulmezoglu AM ,Van Look PF,WHO analysis of maternal death a systematic review , Lancet 2006;367:1066-74)
- Paily VP, Ambujam K, Rajasekharan Nair V, Thomas B. Confidential review of maternal deaths in Kerala: a country case study. BJOG: Int J Obstet Gynecol. 2014;1;121(4):61-6.
- Rocha Filho EA, Costa ML, Cecatti JG, Parpinelli MA, Haddad SM, Pacagnella RC, Sousa MH, Melo Jr EF, Surita FG, Souza JP. Severe maternal morbidity and near miss due to postpartum haemorrhage in a national multicenter surveillance study. Int J Gynecol Obstet. 2015;128 (2):131–6.
- Pandey A, Das V, Agarwal A, Agrawal S, Misra D, Jaiswal N. Evaluation of obstetric near miss and maternal deaths in a tertiary care hospital in north India: Shifting focus from mortality to morbidity. The Journal of Obstetrics and Gynecology of India. 2014 Dec 1;64(6):394-9)
- Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle MH, Ford JB, Joseph KS, Lewis G, Liston RM, Roberts CL, Oats J. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC pregnancy and childbirth. 2009 Dec 1;9(1):55
- Rath WH. Postpartum hemorrhage–update on problems of definitions and diagnosis. Acta obstetricia et gynecologica Scandinavica. 2011 May 1;90(5):421-8.
- Carroli G., Cuesta C., Abalos E., Gulmezoglu A.M. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22:999–1012.
- Lutomski JE, Byrne BM, Devane D, Greene RA. Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG. 2012;119:306–314. doi: 10.1111/j.1471-0528.2011.03198.x.
- Green L, Knight M, Seeney FM, Hopkinson C, Collins PW, Collis RE, Simpson NA, Weeks A, Stanworth SS. The Epidemiology and Outcomes of Women With Postpartum Hemorrhage Requiring Massive Transfusion With 8 or More Units of Red Cells: A National Cross-sectional Study. Obstetric Anesth-esia Digest. 2017 Dec 1;37(4):186-7.
- Van den Akker T1, Brobbel C, Dekkers OM, Bloemenkamp KW Prevalence, Indications, Risk Indicators, and Outcomes of Emergency Peripartum Hysterectomy Worldwide: A Systematic Review and Meta-analysis. Obstet Gynecol. 2016 Dec;128(6):1281-1294
- Maswime S, Buchmann E. A systematic review of maternal near miss and mortality due to postpartum hemorrhage. Int J Gynaecol Obstet. 2017 Apr;137(1):1-7. doi: 10.1002/ijgo.12096. Epub 2017 Jan 24.
Corresponding Author
Dr Manjula M
Asst. Professor, Dept. of O and G, SATH,
Govt. Medical College, Trivandrum India
DOI: https://dx.doi.org/10.18535/jmscr/v6i2.14
