Publication:

A clinical study on management of major primary postpartum haemorrhage at tertiary care centre

Background Postpartum Haemorrhage remains one of the leading causes of maternal morbidity and mortality worldwide. It is estimated that about one quarter to one half of preventable maternal deaths are because of haemorrhage.  It is defined by the royal college of obstetrician and gynaecologist  as blood loss from the genital tract within the first 24 hours after birth of at least 500ml (minor) and at least 1000ml (major) causes of post-partum haemorrhage (PPH) are commonly ascribed to the four Ts (tone, trauma, tissue, 4 thrombin).

Methods This study aimed to assess the clinical practices used by our hospital in managing major PPH. Observational study of the management of PPH over a period of 2 months from March 2023 to April 2023 was carried out. Criteria examined: history of previous PPH causes of PPH, use of oxytocin in the first stage for more than 6 hours. Role of blood transfusion, presence of senior faculty, and type of uterotonics used.

Results There were 50 patients diagnosed with major PPH among which 26 had caesarean delivery. Two major risk factors were analysed, one was Use of oxytocin in first stage for more than 6 hours and history of previous PPH. Uterine atony was commonest cause in 64% of cases.

Conclusions Uterine atony is responsible for most of cases. Early, aggressive, and coordinated intervention by health care professionals is critical in minimizing blood loss to ensure optimal clinical outcomes in management of women with major PPH.