Chohan A, Butt F, Mansoor H, Falak T.
Primary post partum hemorrhage: outcome of different treatment measures.
Biomedica Jan ;22(1):16-20.

This study was carried out to compare the efficacy and safety of different therapeutic measures used for controlling primary postpartum haemorrhage (PPH). The venue of this work was the Department of Obstetrics and Gynaecology Lady Willingdon Hospital Lahore over a period of six months from July 1, 2005 – December 31, 2005. Fifty patients of primary PPH were recruited in this study. After identifying the risk factors for primary PPH thorough history, examination and investigations, these patients were treated medically and surgically to control haemorrhage. Control of bleeding by different measures was secured for the survival of patients. Medical intervention included use of oxytocins, and prostaglandins. Different surgical procedures like manual removal of placenta, suturing of genital tract tears, bimanual uterine compression and packing, stepwise devascularization and caesarean hysterectomy were done. Results of different procedures were analysed by using research proforma. The results show that out o f fifty, fifteen (30%) were booked patients. The major predisposing factor was grand multiparity in twenty-five (50%) patients. The predominant cause was uterine atony in thirty (60%) cases. Twenty (66%) patients were completely cured by different oxytocins. Eight (16%) had manual removal of placenta and two (4%) required evacuation of retained products of conception. Nine (18%) were treated by suturing the tears and lacerations. The commonest morbidity (66%) was anaemia. Mortality rate was 6%. In conclusion there is a need to reduce the alarmingly high maternal mortality and morbidity caused by primary PPH. Its main predisposing factors should be controlled. High parity, illiteracy and ignorance coupled with inadequate maternity services contribute towards this tragedy. If patients reach hospital well in time, effective management of obstetric haemorrhage should be prompt restoration of circulatory volume, accurate diagnosis of the cause of bleeding and early appropriate therapy to arrest the bleeding.

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