Essential that when heavy bleeding occurs, the birth attendants must act quickly as Ian Donald said “while managing PPH

Abstract

This cross-sectional study was conducted in the Department of Obstetrics and Gynecology, DHQ Teaching, Rawalpindi from 1^st January to 31^st December 2019. All the booked, non-booked cases delivered at DHQ and presented with primary PPH were included in the study, for further data analysis, on causes, treatment, and outcome. We reviewed a total of 9122 charts of all the patients who fulfilled our inclusion criteria and gathered data on a structured, pre-tested proforma prepared for the purpose. Those having incomplete records were excluded. In our study primary PPH was defined as the loss of 500 ml or more of blood from the genital tract within 24 hours of the birth of a baby. PPH was labeled as minor (500-1000 ml) or major (more than 1000 ml). Major PPH was divided into moderate (1000-2000 ml) or severe (more than 2000 ml). Women with pre-existing bleeding disorders and women taking therapeutic anticoagulants were excluded. Estimation of blood loss: Blood loss estimation was made by subjective as well as objective assessment. Subjective measures included counting of swabs, estimation of blood clots, and blood in the suction bottle. Objective assessment was made by estimation of Hb levels, need for blood transfusions, clinical condition of the patient, and degree of shock. Active management of the third stage of labor was offered to all women delivering at our institution.