Pakistan Medical and Dental Journal (PMDJ)

assessment was made by estimation of Hb levels, need for blood transfusions, clinical condition of the patient

Asif Naeem — 2022-12-31

In this study, case notes of women who delivered in the hospitals were further explored to identify the women with primary PPH and 70 women were identified. Therefore, the result of this study focused on the 70 cases of women with primary PPH during one year of the study period. For most of the PPH cases in the tertiary institution, the women were mostly non-booked or referred from primary health care centers and private hospitals i.e 45 (64.3%) patients. From the information in the case notes referrals were made when patients had obstructed labor, the prolonged first or second stage of labor, and fetal distress due to meconium staining of liquor. Only 25 (35.7%) women had antenatal care at our institution (booked cases). The age range of the women was between 22 and 42 with a mean age of 29±6 years.

A chi-square test reflected a significant association between booking status 25 (35.7%) and occurrence of PPH (χ2 = 5.714, df = 1, p=0.017). The leading associated risk factors for primary PPH were high parity 18 (25.7%), and anemia 11 (15.7%) followed by birth weight >4 with or without polyhydramnios 9 (12.8%), and multiple pregnancies 8 (11.4%). Others include antepartum haemorrhage 7 (10%), previous history of PPH, 5 (7.1%), preeclampsia 6 (8.5%), chorioamnionitis 4 (5.7%), and abnormal lie/presentation 3 (4.2%). In addition, uterine atony was the most common etiological factor 54 (77.1%) for primary PPH followed by the retained placenta and retained placental tissue in 7 (10%) patients. Other etiologies included

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

Asif Naeem — 2022-12-31

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.

Bleeding was arrested without complications in 21 (30%) with medical management.

Asif Naeem — 2022-12-31

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.

Booked, non-booked cases delivered at DHQ and presented with primary PPH were included in the study

Asif Naeem — 2022-12-31

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.

Information regarding booking status, mode of delivery, possible risk factors, causes of PPH, the therapeutic medical and surgical interventions, and outcomes of the management was collected. The data obtained from the file review were coded and entered in SPSS version 16.0 for analysis. Descriptive statistics have been presented for a consecutive series of patients with primary PPH. Ethical approval from the Ethical Committee of the Institute was sought.