Trine et al and Michael Kramer showed increased incidence in primiparas

Abstract

Multiparas showed an increased incidence of PPH in our study. A study was done in Nigeria by A.E.Olowokere also had more incidences in multiparas.¹³ Whereas in studies conducted by Lill Trine et al and Michael Kramer showed increased incidence in primiparas.^14,15 The NICE guideline on intrapartum care identified eight cross-sectional studies assessing parity as a risk factor for PPH and recommended that grand multiparas (parity 4 or more) should be advised to give birth in an obstetric unit where more emergency treatment options are available.¹⁶ The majority of patients had spontaneous labor followed by augmentation of labor and delivery by cesarean section. Similar results were presented in studies by A.E.Olowokere and Lill Trine et al,^13,14 whereas others showed increased risk with cesarean section and augmentation of labor.¹⁵ A study conducted in Uganda c-section was a risk factor for PPH.¹⁷ Major risk factors identified were high parity, anemia, macrosomia with or without polyhydramnios and antepartum hemorrhage followed by preeclampsia, chorioamnionitis, and malpresentation. Anemia remained a major risk factor in many of the studies followed by the history of PPH in a previous pregnancy, preeclampsia, and increased fetal weight.^18-20

Although active management of the third stage of labor and use of uterotonic drugs helps contract the uterus and hence decreased postpartum blood loss due to relaxed uterine muscles²¹ still Uterine atony remained major etiology in our setup causing PPH in 77% of cases followed by RPOC’s and tears as other main etiologies. Uterine atony remained the major etiology in many reviewed studies. In an Irish study, atony accounted for 76% of the total cases of PPH.²² Incidence of uterine atony was high in the study conducted at AKUH i.