A study of prevalence, causes, risk factors and outcome of severe obstetrics haemorrhage

Abstract

Severe obstetric hemorrhage is the most feared obstetric emergency that can occur to any woman at childbirth. If unattended, the hemorrhage can kill even a healthy woman. The Hemorrhage accounts for nearly one-quarter of all maternal deaths and for almost half of all postpartum deaths in low-income countries. The most common type of obstetric hemorrhage is postpartum hemorrhage (PPH), mainly primary. PPH occurring within 24 h postpartum. Primary PPH is the focus of this article. This was a cross sectional observational study conducted in a Tertiary care hospital conducted from November 2010 to June 2012 having high no of referrals from city as well as periphery. The cross tabulations were used to study the demographic, obstetrical and medical factors in women with severe obstetrical haemorrhage. Total number of patients admitted in labour room was 12,800 and 12,356 patients delivered during this period. Results showed that severe obstetrical haemorrhage (more than 1500 ml) was in 115 patients (prevalence of 0.9%). The prevalence of severe obstetric haemorrhage was 0.9 %. As 85.2% 0f the patients in study were unbooked, it contributed the high prevalence rate & antenatal care. A large proportion of the patients (62%) were multipara. Mortality in this study was 21.73% and morbidity was 78.26%. Most common cause of obstetric haemorrhage in this study was uterine atonic pph. The frequency and impact of severe hemorrhage can be effectively reduced by reducing avoidable risk factors, especially those related to obstetric interventions as increased Caesarean section rate and induction of labor. Other risk factors not amenable to change such as age, ethnic origin, and preexisting medical diseases or bleeding disorders can be minimized by extra vigilance and planned conjoined management.