An Observational Study Of Management Practices And Maternal Outcome Of Postpartum Hemorrhage At A Tertiary Care Centerin Belagavi

Abstract

Introduction: Postpartum hemorrhage is an important cause of maternal mortality and morbidity. These postpartum hemorrhage need to be prevented to decrease overall maternal morbidities and death. Therefore, it is important to understand the risk factors and plan the preventive strategies. Prompt and sequential implementation of management practices including uterotonics, surgical compression sutures and vascular ligation and timely blood product transfusion can prevent maternal deaths and morbidities. Aim and objectives: To study the management practices and maternal outcome of postpartum hemorrhage To determine the risk factors of postpartum hemorrhage Material and methods: The study population constituted postnatal patients referred to or getting admitted to labor room of KAHERs Dr. Prabhakar Kore Hospital, Belagavi and were diagnosed with postpartum hemorrhage was defined as blood loss >500 ml from the genital tract within 24 hours of deliver. Study period was from 1stJanuary 2018 to 31st December 2018. Data was collected with the help of proforma, it included details of the patient, details of previous and present pregnancy, vitals at the time of admission and after delivery, risk factors, amount of blood loss, investigations like CBC,DIC Profile, LFT,RFT. Management practices done according to the hospital protocol to arrest bleeding such as medical measures, surgical measures or a combination of both were recorded .Maternal outcomes in the form of morbidity indicators like DIC,ARDS,ARF,ICU admission, massive blood transfusion and maternal death were noted. Perinatal outcome like LBW,IUD,NICU admission and stillbirth were recorded. Appropriate statistical analysis was done. Results: Incidence of PPH in the present study was 1.86%.most common risk factor for PPH was induction of labor(33.3%) followed by anemia (23.9%) and hypertensive disorders of pregnancy(23.9%).Majority of patients (64.6 %.) had atonic PPH, 11.45% cases hadboth atonic & traumatic PPH.97.9% cases were managed successfully with conservative methods either medical or surgical or a combination of both procedures.7 cases required peripartum hysterectomy. With 2 maternal deaths, outcome of management practices can be considered successful. Conclusion: Postpartum hemorrhage is the major cause of maternal morbidity and maternal death. Most common risk factor for PPH was induction of labor, followed by anemia and hypertensive disorders of pregnancy. To prevent PPH, AMTSL should be practiced for all delivering women. Medical management proved as effective as surgical management of PPH but a combination of both medical and surgical procedure prevents the delay and helps to give appropriate care in short time and thus reduces the morbidity and mortality of PPH.