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Postpartum haemorrhage: a preventable cause of maternal mortality.

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.