Mussarat Sultana, Nabeela Irum, Huma Karamat.
Primary Postpartum Hemorrhage; Causative Factors, Treatment Outcome and its Consequences.
Professional Med J Jan ;25(6):966-70.

Objectives: To see the changing trends in causative factors and various treatment options in pirmary PPH. Study Design: Retrospective study of all the cases who experienced primary postpartum hemorrhage. Period: 4 years i.e: June 2013 to June 2017. Setting: NESCOM Hospital Islamabad. Material and Methods: The sociodemographic characteristics, mode of delivery, antenatal risk factors, causative factors and the treatment received by the patients were extracted from patient?s case notes, entered into computer programme SPSS and analysed. Results: Total number of cases who went into PPH were 77. Majority of patients were belonging to age group 26-34 years. 50% of patients were multiparous whereas 41% were primiparous and 7.7% were grand multiparous. 66% of patients had caesarean section while 34% were delivered vaginally. Commonly identified risk factor was anaemia as in 19% of cases. Others were high parity 12%, prolong labour 7%, augmented labour 5%, and fetal macrosomia in 7% of cases. No risk factors were identified in 43% of cases. Uterine atony was found to be a major causative factor in 70% of cases and genital tract trauma in 23% of cases. 51.9% of patients were successfully managed with medical treatment. Special feature of the medical treatment was the use of tranexamic acid which added to success rate.48% of patients required surgical intervention. Conclusion: It is worthy to note that postpartum hemorrhage can occur in the absence of any identifiable risk factors. Therefore, the anticipation of its occurrence and prompt, adequate, and timely intervention will go a long way in reducing the adverse outcome.

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