Maternity outcome of primary post-partum hemorrhage cases in El-Minia Maternity Hospital 2016-2017 : 2 years study

Abstract : Primary postpartum hemorrhage (PPH) is defined as blood loss from the genital tract of 500 mL or more following a normal vaginal delivery (NVD) or 1,000 mL or more following a cesarean section within 24 hours of birth. PPH contributes significantly to maternal morbidity and mortality worldwide. Women can rapidly hemorrhage and die soon after giving birth. It can be a devastating outcome to many young families. Women giving birth in low-resource settings are at a higher risk of death than their counterparts in resource-rich environments. PPH is a leading cause of maternal deaths globally, contributing to a quarter of the deaths annually.Methods: This was a descriptive study carried out at El-Minia Maternity Hospital, a tertiary referral government hospital in a low-resource setting in El-Minia. Data were obtained from the labor ward birth registers for patients who had a diagnosis of PPH during the period from January 1st, 2016 to December 31th, 2017. The cases notes were retrieved and the demographic, clinical and outcome data were gathered. Blood loss was estimated post-delivery by the attending clinician; either a midwife or a doctor. At this maternity unit, blood loss is not measured but estimated owing to prevailing resource constraints. The SPSS Version 21 statistical tool was used to calculate probability values between 2 years. Simple statistical tests were used on absolute numbers to calculate percentages.Results: There were 11057 deliveries at 2016 and 11146 deliveries at 2017 admitted to El-Minia University Maternity Hospital. In the studied groups of patients, there were 201 (1.88%) cases of PPH at 2016 and 189 cases (1.69%) at 2017. About 67.5% at 2016 and 67.7% at 2017 of the cases had NVD. The majority of the cases (77.0%) had an identifi‌able risk factor for developing primary PPH. The most identifiable risk factor for primary PPH was anemia. As regards lines of management, the study noticed that more cases had been explored and undergone hysterectomy in 2017 than in 2016 and this may be according to the severity of cases, general conditions of the patient and other failed medical interventions that pushed decision in this way resulting in decreasing the mortality ratio in 2017 (3.2%) than in 2016 (8.5%) with high significance (P value = 0.027) and survival of most of the cases.
Conclusion: The incidence of PPH at El-Minia University Maternity Hospital was (1.88 %) in 2016 and 189 cases (1.69%) in 2017 during the study period, lower than that reported elsewhere in similar setting in the literature. Therefore, this study is important, as it documented for the first time the incidence of the most important causes of global maternal deaths in cases admitted to Maternity Unit, El-Minia University. Future studies should involve the effect on maternal outcomes of PPH. This data can help in mobilizing global efforts to improve women’s health.