Bushra Shaheen, Lubna Hassan.
Postpartum hemorrhage: a preventable cause of maternal mortality.
J Coll Physicians Surg Pak Jan ;17(10):607-10.

Objective: To assess the preventable predictors of severe postpartum haemorrhage and the adverse outcome associated with it. Design: Observational study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Hayatabad Medical Complex, PGMI, Peshawar, form January to December 2001. Patients and Methods: All the admitted patients who developed severe postpartum haemorrhage (>1500 ml) were included in the study. Clinical and sociodemographic data was obtained along with results of investigations to categorize the complications encountered. Odds ratio (OR) and 95% confidence intervals were determined. Results: During the study period, 75 out of 4683 obstetrical admissions, developed severe postpartum haemorrhage (1.6 %). About 65% of the patients were admitted with some other complications including obstructed labour, antepartum haemorrhage and eclampsia. The risk factors were grand multiparity (OR=3.4), pre-eclampsia (OR=2.75), antepartum haemorrhage (OR=13.35), active labour of more than 10 hours (OR=46.92), twin delivery (OR=3.25), instrumental delivery (OR=8.62) and caesarean section (OR=9.74). Maternal mortality in these cases was 2.66% and residual morbidity being 40%. Birth attendant other than doctor and delivery outside the study unit were significantly associated with the adverse outcome in these patients. Conclusion: Maternal outcome associated with postpartum haemorrhage is a function of care given during labour and postnatal period with early diagnosis and management of the complication and its risk factors, being the key of good maternal outcome.

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