Frequency and Clinical Outcomes of Women with Postpartum Haemorrhage at a Tertiary Care Hospital Karachi

Abstract

Objective: To determine the frequency of Postpartum haemorrhage, aetiology, and clinical outcomes of PPH presenting at Jinnah Postgraduate Medical Centre, Karachi

Methodology:This was a 5-year cross sectional study conducted at Ward-8 Jinnah Postgraduate Medical Center, including all cases of Postpartum Haemorrhage (PPH) from January 2017 to December 2022.All patients reporting for delivery (either vaginal or cesarean) or referred  diagnosed cases of postpartum haemorrhage from other places reporting to Jinnah Postgraduate Medical Center were included in the study. Patients were enrolled after written consent. Data was collected on a structured proforma and analysed with SPSS version 26.

Results: Patients who developed PPH were 1,128 out of which Primary PPH were 932 (81.8%) and secondary PPH were 205 (18.17%). Among primary PPH, Patients with atony were 481 (42.6%), followed by traumatic delivery 251 (22.2%), Placenta accreta spectrum 141 (12.5%), Rupture uterus 40 (3.54%) and  Uterine Inversion 14 (1.24%) respectively . Secondary PPH was in 205 (18.17%) cases. Causes of  secondary PPH were atony/delayed involution 50,  infection 80 (8.8%), Retained Products of conception were  65  (8.8%) and Arteriovenous malformation were 10 (0.88%). Patients presenting with coagulation disorder were 15 (1.3%) respectively. Both primary and secondary PPH was managed by medical and surgical management. Maternal Mortality of patients who developed PPH was 56 (4.96%). There is a significant relationship between maternal mortality and PPH observed deliveries conducted by traditional birth attendants (P value > 0.0001).

Conclusions: Timely identification, assessment and prompt management of PPH can prevent morbidity and mortality associated with PPH.

KEY WORDS:  Postpartum Haemorrhage, Disseminated intravascular coagulation