Frequency of Maternal Morbidity and Mortality in Women with Primary Postpartum Hemorrhage
DOI:
https://doi.org/10.31580/pjmls.v4i4.2441Keywords:
Primary postpartum hemorrhage (PPH), maternal morbidity, mortalityAbstract
Postpartum haemorrhage is a leading cause of severe maternal morbidity and mortality in both developed and developing countries. We aimed to determine the frequency of maternal morbidity and mortality in women with primary postpartum hemorrhage. This descriptive case study was conducted at Department of Obstetrics & Gynecology, Allied Hospital, Faisalabad, from 15th September 2018 to 14th March 2019. A total of 241 women with PPH, having the age of 18-40 years, and gestational age of 37- 41 weeks were recruited. Patients were evaluated for the presence of sepsis, disseminated intravascular coagulation, acute renal failure, anaemia, and acute respiratory distress syndrome. In this study mean age was detected as 28.96 ± 4.11 years. Majority of the patients 146 (60.58%) were between 18 to 30 years of age. Mean gestational age was 38.87 ± 1.32 weeks. Mean parity was 3.10 ± 0.85 and mean BMI was 28.54 ± 2.54 kg/m2. Sepsis was found in 25 patients (10.37%), disseminated intravascular coagulation in 16 (6.64%), acute renal failure in 21 (8.71%), anaemia in 201 patients (83.40%), acute respiratory distress syndrome in 13 (5.39%) and mortality in 44 (18.26%) patients. This study indicates that frequency of maternal morbidity and mortality in women with primary postpartum hemorrhage is quite high. This necessitates early identification of high-risk pregnancies and provision of urgent, skilled and multidisciplinary intensive care.
References
1. Lutomski J, Byrne B, Devane D, Greene R. Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG. 2012;119(3):306-14.
2. Sentilhes L, Vayssière C, Deneux-Tharaux C. Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). Eur J Obstet Gynecol Reprod Biol. 2016;198:12-21.
3. Hanley GE, Smolina K, Mintzes B, Oberlander TF, Morgan SG. Postpartum hemorrhage and use of serotonin reuptake inhibitor antidepressants in pregnancy. Obstet Gynecol. 2016;127(3):553-61.
4. WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017;389(10084):2105-16.
5. Quibel T, Ghout I, Goffinet F, Salomon LJ, Fort J, Javoise S, et al. Active management of the third stage of labor with a combination of oxytocin and misoprostol to prevent postpartum hemorrhage: a randomized controlled trial. Obstet Gynecol. 2016;128(4):805-11.
6. Ge J, Liao H, Duan L, Wei Q, Zeng W. Uterine packing during cesarean section in the management of intractable hemorrhage in central placenta previa. Arch Gynecol Obstet. 2012;285(2):285-9.
7. ShaoY, Pradhan M. Intrauterine gauze packing in primary postpartum hemorrhage following caesarean section: a clinical study. NJOG 2012;7(3):33-6.
8. Sentilhes L, Vayssière C, Deneux-Tharaux C Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). Eur J ObstetGynecolReprod Biol. 2016;198:12-21.
9. Ahmed SM, Aslam A, Kausar R. Causes of primary postpartum haemorrhage after vaginal delivery.Pak J Med Health Sci. 2016;10(2):600-2.
10. Chandraharan E, Krishna A. Diagnosis and management of postpartum haemorrhage. Br Med J. 2017;358:3875.
11. Green KI, Ojule JD, Faith MC. Primary postpartum haemorrhage at the university of portharcourt teaching hospital: prevalence and risk factors. Nigerian Health J. 2015;15(3):111-7.
12. Agten AK, Passweg D, von Orelli S, Ringel N, Tschudi R, Tutschek B. Temporal trends of postpartum haemorrhage in Switzerland: a 22-year retrospective population-based cohort study. Swiss Med Wkly. 2017;147:14551.
13. Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: A systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22:999-1012.
14. Francois KE, Foley MR. Antepartum and pospartum hemorrhage. En: Gabbe SG, Niebyl JR, Simpson JL, Landon MB, Galan HL, Jauniaux ERM, et al, Editors. Obstetrics. Normal and Problem Pregnancies. Seventh edition; 2017. p. 395-424.
15. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva: World Health Organization; 2012. (WHO Guidelines Approved by the Guidelines Review Committee) [visitado 2017 Sep 15]. Disponible en: http://www.ncbi. nlm.nih.gov/books/NBK131942/
16. OB Hemorrhage Toolkit V 2.0 California Maternal Quality Care Collaborative [visitado 2017 Sep 15]. Disponible en: https://www.cmqcc.org/resources-tool-kits/toolkits/ob-hemorrhage -toolkit
17. Tsu VD. Postpartum haemorrhage in Zimbabwe: a risk factor analysis. Br J Obstet Gynaecol. 1993;100:32733.
18. Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B. Prevalence and risk factors of severe obstetric haemorrhage. BJOG Int J Obstet Gynaecol. 2008;115:1265-72.
19. Ayadi AME, Nathan HL, Seed PT, Butrick EA, Hezel-grave NL, Shennan AH, et al. Vital sign prediction of adverse maternal outcomes in women with hypovo-lemic shock: The role of Shock Index. PLOS ONE. 2016;11:e0148729.
20. Rubio-Romero JA, Guevara-Cruz OA, Gaitán-Duarte H. Validity of visual estimation of blood loss as diagnostic tool in severe post partum hemorrhage in an university hospital. Bogotá. 2007. Rev Fac Med. 2010;58:173-84.
21. Rubio-Romero JA, Gaitán-Duarte HG, Rodríguez-Malagón N. Concordancia entre la estimación visual y la medición del volumen recolectado en una bolsa del sangrado intraparto en mujeres con parto normal en Bogotá, Colombia, 2006. Rev Colomb Obstet Ginecol. 2016;59:92-102.
22. Naz H, Sarwar I, Fawad A, Nisa A. Maternal morbidity and mortality due to primary pph: experience at Ayub teaching hospital Abbottabad. J Ayub Med Coll Abbottabad 2008;20(2):59-65
23. Chandrika S. Kodla. A study of prevalence, causes, risk factors and outcome of severe obstetrics haemorrhage. J SciInnov Res. 2015;4(2):83-7.
24. Haeri S, Dildy GA III. Maternal mortality from hemorrhage. Semin Perinatol 2012;36:48-55.
25. Goffman D, Nathan L, Chazotte C. Obstetric hemorrhage: a global review. Semin Perinatol 2016;40:96-8.
26. Sentilhes L, Merlot B, Madar H, et al. Postpartum hemorrhage: prevention and treatment. Expert Rev Hematol 2016;9:1043-61.
27. Joseph K, Rouleau J, Kramer M, Young D, Liston R, Baskett T. Investigation of an increase in postpartum haemorrhage in Canada (for the Maternal Health Study Group of the Canadian Perinatal Surveillance System). BJOG An International Journal of Obstetrics and Gynaecology 2007;114(6):751–9.
28. RCOG (Royal College of Obstetricians and Gynaecologists) 2009. Prevention and management of postpartum haemorrhage: Green-top guideline no. 52. London: RCOG.
29. Royal Women’s Hospital 2012. Labour: management of post-partum haemorrhage including postnatal care policy, guideline and procedure manual. Melbourne: Royal Women’s Hospital.
30. WHO (World Health Organization) 2012. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: WHO.
31. Anderson J & Etches D 2007. Prevention and management of postpartum hemorrhage. American Family Physician. Viewed 8 May 2013.
32. Welsh A, Gatt S, Somerset D, Popham P, Ogle R. Guidelines for the use of recombinant activated factor VII in massive obstetric haemorrhage. Australian and New Zealand Journal of Obstetrics and Gynaecology 2008;48:12–16.
2. Sentilhes L, Vayssière C, Deneux-Tharaux C. Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). Eur J Obstet Gynecol Reprod Biol. 2016;198:12-21.
3. Hanley GE, Smolina K, Mintzes B, Oberlander TF, Morgan SG. Postpartum hemorrhage and use of serotonin reuptake inhibitor antidepressants in pregnancy. Obstet Gynecol. 2016;127(3):553-61.
4. WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017;389(10084):2105-16.
5. Quibel T, Ghout I, Goffinet F, Salomon LJ, Fort J, Javoise S, et al. Active management of the third stage of labor with a combination of oxytocin and misoprostol to prevent postpartum hemorrhage: a randomized controlled trial. Obstet Gynecol. 2016;128(4):805-11.
6. Ge J, Liao H, Duan L, Wei Q, Zeng W. Uterine packing during cesarean section in the management of intractable hemorrhage in central placenta previa. Arch Gynecol Obstet. 2012;285(2):285-9.
7. ShaoY, Pradhan M. Intrauterine gauze packing in primary postpartum hemorrhage following caesarean section: a clinical study. NJOG 2012;7(3):33-6.
8. Sentilhes L, Vayssière C, Deneux-Tharaux C Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). Eur J ObstetGynecolReprod Biol. 2016;198:12-21.
9. Ahmed SM, Aslam A, Kausar R. Causes of primary postpartum haemorrhage after vaginal delivery.Pak J Med Health Sci. 2016;10(2):600-2.
10. Chandraharan E, Krishna A. Diagnosis and management of postpartum haemorrhage. Br Med J. 2017;358:3875.
11. Green KI, Ojule JD, Faith MC. Primary postpartum haemorrhage at the university of portharcourt teaching hospital: prevalence and risk factors. Nigerian Health J. 2015;15(3):111-7.
12. Agten AK, Passweg D, von Orelli S, Ringel N, Tschudi R, Tutschek B. Temporal trends of postpartum haemorrhage in Switzerland: a 22-year retrospective population-based cohort study. Swiss Med Wkly. 2017;147:14551.
13. Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: A systematic review. Best Pract Res Clin Obstet Gynaecol. 2008;22:999-1012.
14. Francois KE, Foley MR. Antepartum and pospartum hemorrhage. En: Gabbe SG, Niebyl JR, Simpson JL, Landon MB, Galan HL, Jauniaux ERM, et al, Editors. Obstetrics. Normal and Problem Pregnancies. Seventh edition; 2017. p. 395-424.
15. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva: World Health Organization; 2012. (WHO Guidelines Approved by the Guidelines Review Committee) [visitado 2017 Sep 15]. Disponible en: http://www.ncbi. nlm.nih.gov/books/NBK131942/
16. OB Hemorrhage Toolkit V 2.0 California Maternal Quality Care Collaborative [visitado 2017 Sep 15]. Disponible en: https://www.cmqcc.org/resources-tool-kits/toolkits/ob-hemorrhage -toolkit
17. Tsu VD. Postpartum haemorrhage in Zimbabwe: a risk factor analysis. Br J Obstet Gynaecol. 1993;100:32733.
18. Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B. Prevalence and risk factors of severe obstetric haemorrhage. BJOG Int J Obstet Gynaecol. 2008;115:1265-72.
19. Ayadi AME, Nathan HL, Seed PT, Butrick EA, Hezel-grave NL, Shennan AH, et al. Vital sign prediction of adverse maternal outcomes in women with hypovo-lemic shock: The role of Shock Index. PLOS ONE. 2016;11:e0148729.
20. Rubio-Romero JA, Guevara-Cruz OA, Gaitán-Duarte H. Validity of visual estimation of blood loss as diagnostic tool in severe post partum hemorrhage in an university hospital. Bogotá. 2007. Rev Fac Med. 2010;58:173-84.
21. Rubio-Romero JA, Gaitán-Duarte HG, Rodríguez-Malagón N. Concordancia entre la estimación visual y la medición del volumen recolectado en una bolsa del sangrado intraparto en mujeres con parto normal en Bogotá, Colombia, 2006. Rev Colomb Obstet Ginecol. 2016;59:92-102.
22. Naz H, Sarwar I, Fawad A, Nisa A. Maternal morbidity and mortality due to primary pph: experience at Ayub teaching hospital Abbottabad. J Ayub Med Coll Abbottabad 2008;20(2):59-65
23. Chandrika S. Kodla. A study of prevalence, causes, risk factors and outcome of severe obstetrics haemorrhage. J SciInnov Res. 2015;4(2):83-7.
24. Haeri S, Dildy GA III. Maternal mortality from hemorrhage. Semin Perinatol 2012;36:48-55.
25. Goffman D, Nathan L, Chazotte C. Obstetric hemorrhage: a global review. Semin Perinatol 2016;40:96-8.
26. Sentilhes L, Merlot B, Madar H, et al. Postpartum hemorrhage: prevention and treatment. Expert Rev Hematol 2016;9:1043-61.
27. Joseph K, Rouleau J, Kramer M, Young D, Liston R, Baskett T. Investigation of an increase in postpartum haemorrhage in Canada (for the Maternal Health Study Group of the Canadian Perinatal Surveillance System). BJOG An International Journal of Obstetrics and Gynaecology 2007;114(6):751–9.
28. RCOG (Royal College of Obstetricians and Gynaecologists) 2009. Prevention and management of postpartum haemorrhage: Green-top guideline no. 52. London: RCOG.
29. Royal Women’s Hospital 2012. Labour: management of post-partum haemorrhage including postnatal care policy, guideline and procedure manual. Melbourne: Royal Women’s Hospital.
30. WHO (World Health Organization) 2012. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: WHO.
31. Anderson J & Etches D 2007. Prevention and management of postpartum hemorrhage. American Family Physician. Viewed 8 May 2013.
32. Welsh A, Gatt S, Somerset D, Popham P, Ogle R. Guidelines for the use of recombinant activated factor VII in massive obstetric haemorrhage. Australian and New Zealand Journal of Obstetrics and Gynaecology 2008;48:12–16.
