Post partum hemorrhage and its predisposing factors In WHO Multi-Country Survey on Maternal and Newborn Health, Pakistan

Abstract

Objective: To determine the incidence and predisposing factors for Postpartum hemorrhage (PPH)among Pakistani women delivering in 16 referral facilities included in World health organization (WHO) Multicountry survey (MCS) on maternal and new born health (MNH), 2011.
Methodology: This cross-sectional study was conducted in 16 referral level health care facilities across Pakistan, from 1st March to 30th May, 2011 to evaluate the incidence and management strategies linked to maternal and neonatal mortalities. Data were collected from the hospital records of all women delivering in the studied facilities or admitted within 7 days of delivery or abortion with near miss maternal mortality. The data was entered and analyzed on SPSS. This study is a sub analysis of 217 women with PPH among the total population of 13175 delivered women. The incidence and predisposing factors of women with PPH were compared to the rest of the study population.
Results: Out of a total of 13175 women included in the study 217 (1.6%) suffered from PPH. The average maternal age was similar in both groups. Of the total 217 women with PPH, 32.0% women with PPH delivered preterm compared to 11%in the non PPH group. Cesarean delivery (51% vs 34%) and previous cesarean section 34%vs19% were significantly associated with PPH. Similarly, general anesthesia28.4%vs 3.1% for regional analgesia and antibiotics use 40.5% vs21.7%were associated with PPH. Illiteracy was associated with PPH 41%vs 31% (p 0.001). There were 18(8.3%) maternal deaths contributing to 47.3% of overall deaths in the study.
Conclusion: PPH is still responsible for an unacceptably large proportion of maternal mortality in Pakistan. Improved literacy rates, good nutrition, iron supplementation during antenatal visits and availability of better health facilities at the door step can reduce severe morbidity and maternal deaths from PPH.