RISK FACTORS, CAUSES AND MANAGEMENT OF PRIMARY POST PARTUM HEMORRHAGE AT POF HOSPITAL WAH CANTT.
To determine the causes, frequency, risk factors and treatment options in women who suffered from primary post partum hemorrhage in POF Hospital Wah Cantt.
Study Design: Descriptive Study.
Place and duration: Department of Obs/gynae POF Hospital Wah Cantt.
This study was carried out at the department of obstetrics and gynecology POF Hospital from 1st January 2021 to 31st Dec 2021. All patients both booked and unbooked were included with age ranging from 21 to 42 years according to inclusion criteria. Risk factors causes and management of these cases were noted. Data was collected from registers in labour ward and operation theatre and was recorded in specially designed Performa.
The study included 2600 cases of deliveries. Primary PPH was observed in 80 cases (3.076%) . No maternal death occurred due to PPH in this one year study. 50% of the patients were in the age group between 24-29 years and 45 (56.25%) were multi gravidas.
The most common cause of primary PPH was uterine atony (38 cases) 47.5%, followed by perineal trauma, cervical tears, vaginal tears (32 cases) 40%. No case of ruptured uterus was observed. 38 (47.5%) cases of primary PPH due to uterine atony received medical treatment. Regarding surgical treatment, uterovaginal packing (along with uterotonics) was done in 16 (20%) cases while stitching of perineal tear was done in 32 cases (40%).
Manual removal of retained placenta was done in 10 (12.5%) while peripartum hysterectomy was done in 4 (5%) patients who did not responded to above treatment. Antenatal anemia was the most frequent risk factor in 18 (22.5%) .
In all the observed cases of post partum hemorrhage, uterine atony was the most common cause and anemia was the main risk factor. PPH can be avoided by identification of high risk patients and active management of third stage of labour. Improved literacy rate, good nutrition and iron supplementation can reduce severe morbidity and availability of better health facilities at the doorstep is the need of today.
Postpartum hemorrhage, uterine atony, perineal tears.
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