Fehmida Shaheen, Jasia Jabeen.
Postpartum Hemorrhage: still a challenge.
J Rawal Med Coll Jan ;7(2):77-81.

Objective: To determine prevalence rate of postpartum haemorrhage (PPH), pre-disposing factors and causes of PPH and to study the maternal morbidity and mortality associated with it. Methods: This study was carried out at Holy Family Hospital, Rawalpindi, Gynae & Obs. Unit-I, from January 2000 to December 2001. It was a retrospective study. The case files of women with PPH were reviewed. The detailed information about age, parity, booking status, predisposing and etiological factors was noted. The type of PPH and its management options were recorded and maternal mortality and morbidity assessed. Results: There were 6844 deliveries during the study period of 2 years. A total of 294 cases developed the complication of post-partum hemorrhage (prevalence of 3.4%). The highest incidence (41%, 37%) occurred in women of medium parity and high parity. The type of PPH in majority of cases (91%) was primary and only 26 cases reported with secondary PPH. Of the pre-disposing factors, prolonged labour (55%), multi-parity (45%), previous 3rd stage abnormalities (7%), PIH (37%) and abruptio placentae (7%) were important. The commonest cause of PPH was atonic uterus (65%) followed by traumatic lesions (33%) and retained placenta (27%). The maternal morbidity in the cases was assessed in terms of hospital stay and other complications like coagulation failure, renal failure and urinary tract infection. There were three maternal deaths in the cases studied. Conclusion: If effective measures are taken to ensure provision of antenatal care to all pregnant ladies, safe home and hospital deliveries and timely referral of such cases to appropriate facilities can reduce the maternal complications. Proper awareness and availability of contraception is mandatory to reduce maternal morbidity and mortality due to this cause.

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