“Post partum hemorrhage: causes and management”

Abstract

BackgroundPost partum hemorrhage is defined as blood loss of 500 ml or above. It is the most common cause of pre-mature mortality of women world wide. Our objective was to evaluate the most common etiology and method of management of Post partum Hemorrhage in a tertiary care hospital of Karachi.FindingsIt was a cross sectional study conducted at Liaquat National Hospital Karachi, during the period of July 2011 to May 2012. Review include mode of delivery, possible cause of postpartum hemorrhage, supportive, medical and surgical interventions. All the women admitted with post partum hemorrhage or develop PPH in hospital after delivery were included in our study. Bleeding disorder and use of anticoagulants were set as exclusion criteria. Diagnosis was made on the basis of blood loss assessment which was made via subjective and objective evaluation.During the targeted months, out of total 1493 deliveries (26/1493 = 1.741%) 26 cases of post partum hemorrhage were reported with a mean age of 26.153 ± 7.37. No deaths were reported and all cases were referred and unbooked cases. All Patients were conscious, tachycardiac and hypotensive. Most of the women were suffering from hemorrhage during or after the birth of their 1st child. Primary post partum hemorrhage emerge as the most common type of post partum hemorrhage and uterine atony was detected as the most common cause of primary post partum hemorrhage. Retained products of conception was the most common cause of secondary post partum hemorrhage and hysterectomy was found to be the most frequent method of management of post partum hemorrhage.ConclusionThis study highlights the existing variable practices for the management of postpartum hemorrhage. Hemorrhage associated morbidity and mortality can be prevented by critical judgment, early referral and resuscitation by attendants. Introduction of an evidence-based management model can potentially reduce the practice variability and improve the quality of care.

Analysis of 339 pregnancies in 181 women with 13 different forms of inherited thrombocytopenia

“…1 Although the majority of these deaths occur in low income countries, excessive bleeding at delivery is also frequent in high resource countries. In Australia, Canada and the US, 3-7% of deliveries in 2005 were complicated by primary postpartum hemorrhage.…”

An overview of women with post-partum haemorrhage in a tertiary care centre at capital of Madhya Pradesh, India

“…7 Other studies reported figures of 38% and 28%. 5,6 Coagulopathy was found in 46% (HELLP, DIC, Hepatic failure), traumatic PPH in 30% (Many patients had more than one cause).…”

“…This result is consistent with that of other researchers, 91.08% and 100% . 5,6 65% patients delivered at our tertiary centre, 32% had delivered at local hospitals and referred to us after they landed up in PPH.…”

Effect of Active versus Expectant Nursing Management of Third Stage of Labor on Post-Partum Hemorrhage

“…PPH has conventionally been defined as loss of more than half liter of blood coming through the vagina within the first twenty four hours after birth [3]. Prevention of this life threading complication; includes diminishing anticipated risk factors and stimulating the uterus to contract soon after the fetus is born through the third stage of labor [1].…”

“…Life-threatening primary postpartum hemorrhage (PPH) occurs in around four percent of vaginal deliveries and two to eleven percent of all deliveries [1]. According to the WHO, it is a chief cause of maternal morbidity, and one of the pinnacle three origins of maternal mortality in both developed and developing countries [2].…”