Lubna Ejaz, Nilofer Rasheed.
Post Partum Haemorrhage analysis of 108 cases.
J Surg Jan ;21-22:14-8.

108 consecutive cases of post partum haemorrhage (PPH) managed in a referral hospital were analysed retrospectively for risk factors, pathology, modes of treatment and the outcome. Risk factors identified were multiparity 78 (72.2%), operative delivery 40 (37.0%), placental abnormalities 16 (14.8%), bad obstetric history 11 (10.1%), mismanaged delivery 6 (5.5%), uterine abnormalities 2 (1.8%). In 6 (5.5%) patients no such factor could be determined. Underlying pathology was uterine relaxation 73 (67.6%), genital tract injuries 14 (12.9%), retained POC's 19 (17.6%) and DIC 2 (1.8%). Haemorrhage was controlled by oxytosic drugs in 60 cases of uterine inertia (82.1%), by uterine evacuation in 16 cases of retained POCs (14.2%) and simple repair in 9 cases of genital tract injuries (64.2%). Uterine vessel ligation was tried in 3, and internal iliac artery ligation in 4 and these were successful in 2 and 3 cases respectively. Hysterectomy was done in 18 patients (16.6%). Complications in 46 operated patients were: pyrexia in 25 (54.3%), abdominal wound infection in 7 (15.2%), urinary tract infection in 4 (8.6%). Vesio-vaginal fistula in 1 (2.1%). 3 patients (2.7%) died, all after surgical treatment. Results showed a high association of PPH with multiparity leading to uterine atony usually managable by drugs. Conservative procedures sufficed in many, but a significant proportion still required hysterectomy. Mortality, though comparable to what is reported, is noticeable.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com