primary PPH diagnosed during the study period received additional administration of 10 IU intravenous uterotonic (oxytocin)

Abstract

All the patients having PPH, 70 (100%) had active management of the third stage of labor.  All the cases of primary PPH diagnosed during the study period received additional administration of 10 IU intravenous uterotonic (oxytocin), 1 gram intravenous Tranexamic acid, and 800mg misoprostol per rectal. Bleeding was arrested without complications in 21 (30%) with medical management. In our tertiary care center, EUA and uterine packing were done in 27 (38.5%) patients and bleeding was successfully arrested in 90% of patients. 

B- lynch was applied in 6 patients,  who went into PPH during cesarean section. Bleeding was successfully arrested in 4 (66%) patients. Internal iliac ligation was done in 1 patient where uterine packing failed and was unsuccessful. Hysterectomy was performed in 9 (12.8%) patients, 3 patients had morbidly adherent placenta, 2 cases failed uterine packing, 1 case of uterine rupture, and 3 cases where B-lynch and internal iliac ligation failed.  Evacuation of the placenta and placental remains was done in 7 (10%) cases. However, repair of tear/laceration was only documented in 3 (4.2%) cases. Maternal death due to PPH was reported in 1 (1.4%) case.