POSTPARTUM HEMORRHAGE (PPH)

A MAJOR KILLER OF WOMEN

Abstract

OBJECTIVES: 80 cases of PPH were analyzed retrospectively to assess the risk factor association, mode
of treatment and outcome. STUDY DESIGN: Retrospective study. PERIODS: 02 years, from June 1999
to May 2002. SETTING: Peoples Medical College Hospital, Nawabshah. PATIENTS & METHODS: 180
cases of PPH were analyzed, keeping in view their age, parity, booking status, mode, type and place of
delivery. The efficacy of obstetric care was assessed by maternal morbidity and mortality related to PPH and
its treatment. RESULTS: Out of 180 patients with PPH, 117 (65 %) were referred cases while 63 (35 %)
were delivered at PMCH Nawabshah. Risk factors identified were increasing maternal age, grand multi
parity, lack of antenatal care, operative and instrumental deliveries. Underlying pathology was uterine atony
68.33 %, retained product of conceptions 20.55 %, GT. injuries 8.33 % and D.I.C 2.77 %. Out of 180
patients, 71.11 % patients gave response to medical treatment, 20.55 % needed evacuation of uterus. Uterine
packing done in 15.55 % of cases and simple repair of GT. injuries done in 6.66 %. Obstetrical
hysterectomies account for 10 % of cases. Complications in operated patients were paralytic ileus in 6.66
%. chest infection 5.55 %. DVT in 1.11 % and pelvic infection in 5.55 % patients. During study period, 72
maternal deaths occurred and PPH contributed 31.94 % of it. CONCLUSION: The study revealed that an
effective ante, intra and postpartum care, blood bank facilities and an alert action by Obstetric team are very
important in prevention of mortality and mobility of this challenging problem. Training of resident surgeons
and early involvement of skilled and senior personnel are needed to eliminate the substandard care and to
reduce the large number of abdominal hysterectomies which were carried out in present series.