PRIMARY POSTPARTUM HEMORRHAGE
CAUSATIVE FACTORS, TREATMENT OUTCOME AND ITS CONSEQUENCES.
Keywords:Primary Postpartum Hemorrhage (PPH), peripartum hysterectomy
Objectives: To see the changing trends in causative factors and various treatment
options in pirmary PPH. Study Design: Retrospective study of all the cases who experienced
primary postpartum hemorrhage. Period: 4 years i.e: June 2013 to June 2017. Setting:
NESCOM Hospital Islamabad. Material and Methods: The sociodemographic characteristics,
mode of delivery, antenatal risk factors, causative factors and the treatment received by the
patients were extracted from patient’s case notes, entered into computer programme SPSS
and analysed. Results: Total number of cases who went into PPH were 77. Majority of patients
were belonging to age group 26-34 years. 50% of patients were multiparous whereas 41% were
primiparous and 7.7% were grand multiparous. 66% of patients had caesarean section while
34% were delivered vaginally. Commonly identified risk factor was anaemia as in 19% of cases.
Others were high parity 12%, prolong labour 7%, augmented labour 5%, and fetal macrosomia
in 7% of cases. No risk factors were identified in 43% of cases. Uterine atony was found to be
a major causative factor in 70% of cases and genital tract trauma in 23% of cases. 51.9% of
patients were successfully managed with medical treatment. Special feature of the medical
treatment was the use of tranexamic acid which added to success rate.48% of patients required
surgical intervention. Conclusion: It is worthy to note that postpartum hemorrhage can occur
in the absence of any identifiable risk factors. Therefore, the anticipation of its occurrence and
prompt, adequate, and timely intervention will go a long way in reducing the adverse outcome.