DOI: https://doi.org/10.53350/pjmhs20221611778 ORIGINAL ARTICLE 778 P J M H S Vol. 16, No. 11, November, 2022 Frequency and Clinical Outcomes of Women with Postpartum Hemorrhage at a Tertiary Care Hospital BUSHRA BEGUM RAMEJO 1 , MUBASHIR AHMED RAMEJO 2 , SANOBER SOOMRO 3 , MEHTAB ALI TUNIO 4 , MUSHARRAF AHMED RAMEJO 5 1 Assistant Professor Obs & Gynae Department, Incharge Unit-2, Khairpur Medical College Khairpur Mirs 2 Final year MBBS student Karachi Institute of Medical Sciences 3 Women Medical Officer, Gynae Unit-2, Department, Kausar Hospital, Khairpur Mirs 4 Second Year MBBS student Kairpur Medical College Khairpur Mirs 5 Third Year MBBS Student Bahria Medical College, Karachi Corresponding author: Bushra Begum Ramejo, Email: bushra_bushra_2009@yahoo.com ABSTRACT Background and aim: Postpartum hemorrhage (PPH) is still a leading cause of maternal morbidity and mortality globally. Postpartum hemorrhage is characterized as excessive bleeding (> 500 ml) from the vaginal tract following childbirth. The present study aimed to determine the frequency and clinical outcomes of women with postpartum hemorrhage. Materials and Methods: This cross-sectional study was conducted on 1346 patients who underwent vaginal delivery in the department of obstetrics and gynecology, Kausar Hospital, Khairpur Mirs from March 2021 to March 2022. The study included all the women who had postpartum hemorrhage following vaginal birth in the labor room or who were referred with primary postpartum hemorrhage. Patients with prior history of bleeding disorders and on warfarin were excluded from the study. SPSS version 26 was used for data analysis. Results: Of the total 1346 patients, the prevalence of postpartum hemorrhage was 12.6% (n=170). Out of 170 PPH cases, the incidence of primary and secondary PPH was 138 (81.2%) and 32 (18.8%) respectively. The age-wise distribution of patients were as follows: 26 (15.3%) had <20 years, 62 (36.4%) in 21-30 years, 68 (40.1%) in 31-40 years, and 14 (8.2%) in >40 years. The incidence of primiparas, multipara, and grand multipara were 34 (20%), 58 (34.1%), and 78 (45.9%) respectively. The booked and unbooked patients were 56 (32.9%) and 114 (67.1%) respectively. Among 170 PPH patients, the incidence of spontaneous vaginal delivery, instrumental delivery, and cesarean section were 52 (30.6%), 56 (32.9%), and 62 (36.5%) respectively. The major causes of PPH was uterine atony, perineal and vaginal tears, and prolong labor found in 112 (65.9%), 56 (32.9%), and 38 (22.4%) respectively. Conclusion: The present study concluded that the prevalence of PPH was 12.6% among total cases. Primary PPH was more prevalent than secondary PPH and uterine atony was the most common cause followed by perineal and vaginal tears and prolong labor. Additionally, unbooked patients were more susceptible to PPH. Risk factors assessment, unnecessary induction, and third stage labor active management can prevent the PPH. Keywords: Postpartum hemorrhage, Clinical outcomes, Uterine atony INTRODUCTION Postpartum hemorrhage is an excessive bleeding after (> 500 ml) from the vaginal tract following childbirth. The blood loss (>500 ml) within 24 hours of childbirth is usually referred to as a primary postpartum and excessive blood loss after 1 st day and puerperium 42 days is secondary postpartum hemorrhage [1]. Primary PPH is a more severe and life-threatening condition that contributes to the majority of mortality cases worldwide [2]. The estimated maternal mortality caused by primary PPH are 600, 000 cases and mostly occur in lower socioeconomic countries [3]. In Pakistan, the incidence of PPH is 34% [4]. The primary cause of PPH was uterine atony causing 75% to 90% cases of PPH [5, 6]. Other major causes are laceration of lower genital tract, previa, uterine inversion, accreta, and rupture uterus. Maternal complications such as acute tubular necrosis, anemia, renal shutdown, shock, and disseminated intra vascular coagulation (DIC) were caused by postpartum hemorrhage. PPH management includes multiple blood transfusion associated complications such as bladder injury, respiratory distress, uterine packing, and sepsis during postpartum hysterectomy [7]. The higher prevalence of PPH is mainly due to lack of knowledge regarding antenatal screening significance in high risk patients and childbirth at home by unqualified birth attendants in developing countries [8]. Majority of complications associated with pregnancy and childbirth in Pakistan are caused by lack of intrapartum care and skilled antenatal during labor contributing to maternal and fetal loss [9]. PPH therapeutic and prophylaxis management could be done by various medical preparations such as PGF2 alpha, syntometrine, misoprostol, Oxytocin, and ergometrine. The PPH management includes underlying cause management and resuscitation. Other life saving measures include hysterectomy, compression sutures, uterine artery embolization, and internal iliac artery ligation [10]. Though, numerous studies have been done on causes, morbidity, and mortality of PPH. However, there is paucity of data on the frequency and clinical outcomes of postpartum hemorrhage in women. Therefore, the present study aimed to determine the frequency and clinical outcomes in women with postpartum hemorrhage. METHODOLOGY This cross-sectional study was conducted on 1346 patients who underwent vaginal delivery in the department of obstetrics and gynecology, Kausar Hospital, Khairpur Mirs from March 2021 to March 2022. The study included all the women who had postpartum hemorrhage following vaginal birth in the labor room or who were referred with primary postpartum hemorrhage. Patients with prior history of bleeding disorders and on warfarin were excluded from the study. Patients meeting the inclusion criteria were enrolled. For PPH frequency calculation, the overall deliveries occurred during the study period was recorded. Patients were investigated about prior antenatal care and previous antenatal record to verify the PPH causes in booked and unbooked patients. Subsequent to written informed consent, demographic details such as age, gestational duration, and parity were recorded on a predesigned proforma. Other details included labor duration, induced or augmented labor, episiotomy, spontaneous delivery, placental delivery time, and pad soaked since delivery were recorded. For the patient’s hemodynamic status, vital signs were monitored and the uterus was examined for the confirmation of contraction. Uterine inversion or genital tract tear was tracked by exploration of genital tract. Radiological images confirmed the retained placental tissue. SPSS version 26 was used for data analysis. Quantitative variables were expressed as mean and standard deviation. Qualitative variables such as PPH different cause’s i.e perineal tear, uterine rupture, uterine atony, uterus inversion, and retained placenta were described as frequency and percentage. All the descriptive statistics were done by taking 95% confidence interval and 5% level of significance.