third stage of labor and use of uterotonic drugs helps contract the uterus and hence decreased postpartum
Abstract
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.e (96%).11
Medical management of PPH with uterotonic drugs was successful in 30% of patients and these patients did not need any mechanical or surgical treatment. Many international articles support the use of tranexamic acid and misoprostol along with oxytocin in the treatment of PPH with significant decreases in rates of acute cases of PPH and mean blood loss.23-25 Uterine packing was done in 30 (43%) patients and bleeding was successfully arrested in 27 (90%) patients. Similar results were shown in a study conducted in 2008 by Khairunnisa where uterovaginal packing was successful in 89.14% of patients.26
