BY DR TULIKA JOSHIDR REETA HANSDA (HOD)

DR ANIMA KERKETTA (SPECIALIST)

STUDY OF SECONDARY POSTPARTUM

HEMORRHAGE CASES

INTRODUCTION

Definition : Hemorrhage occuring after 24 hrs of delivery till 6 weeks post partum.

Incidence : ~1% of all deliveries.

AIMS AND OBJECTIVES

To assess prevalence, morbidity and management pattern of secondary postpartum hemorrhage cases in Bokaro General Hospital.

MATERIALS AND METHODS

Retrospective analytical study.Inclusion criteria: All patients admitted in LR

& Gynaecology ward of Bokaro General Hospital as secondary postpartum hemorrhage case

Duration of study: January 2006 to January 2010

DATA RECORDED

• Data collected LR birth records & admission records.

• Data recorded was:– Age – Parity – Booking history– Place and mode of delivery– Interval between delivery and bleeding– Hemoglobin at the time of admission– Management

CONTINUED

• Management :– Resuscitation & blood transfusion– Definitive treatment:

• Conservative : uterotonics, antibiotics etc• Surgical :

– Dilatation curettage– Laparotomy with conservative surgery– Laparotomy with radical surgery

• The result was expressed as percentage of cases & mean values were calculated.

The main outcome measures used for analysis were: Cause of secondary PPH Place and mode of delivery Management pattern

RESULTS

Total no. of cases - 24Total number of deliveries in this period -

9551Incidence: 24/9551*1000 = 2.51 per 1000

deliveries

Age distribution of patients

Table showing booking status

Booking status No. of patients Perentage

Booked 6 25%

Unbooked 18 75%

Parity wise distribution

Interval of bleeding from delivery

Mode & place of delivery

45.833%

41.66% 54.67%

CAUSES

Hemoglobin on admission

Age In yrs

Mean Hb:9.37 gm%

MANAGEMENT

Blood transfusions No. of patients percentage

None 6 25%

<2 units 12 50%

>2 units 6 25%

Management pattern

58.33%41.66%

8.33%

4.17%

DURATION OF HOSPITAL STAY

Mean : 4 daysRange : 2- 12 daysRe-admissions: 4 cases

Discussion

Study Incidence

Vaginal deliveries

LSCS Primi Multi

Dongol et al (2010)

3.1/1000 deliveries

84.21% 15.78% 31.57% 68.42%

Fatemeh Hoveyda et al (2001)

6.89/1000 deliveries

88.63% 11.36% 42.42% 57.57%

Ober & Grady (1960)

- VD-45%D&E-42%

3% 23% 77%

Present study

2.51/1000 deliveris

58.33% 41.67% 58.33% 41.67%

Causes

Study Abnormal placentation

Infection

Fatemeh Hoveyda et all(2001)

45.45% 13%

Khong & Khong (1993)

44.37% 4.14%

King et al (1989) 42% 12%

Present study 50% 20.83%

Management

Study Blood transfusions

D&E Major surgery

Fatemeh Hoveyda et al (2001)

17% 56% Hystrectomy-3/132Laparotomy-2/132

King et al (1989)

24% 87% Hysterectomy-2/83

Ober & Grady (1960)

- 54% Hysterectomy 41+5%

Present study

75% 42% Hysterectomy-1/24Laparotomy-2/24

CONCLUSION

Secondary postpartum hemorrhage can result in significant maternal morbidity & if left uncared for or mismanaged it may result in maternal mortality. A proper antenatal care along with institutional deliveries will help in reducing the incidence. Apart from that there is a major necessity of maintaining strict asepsis during the intrapartum procedures.

REFERENCES

1. Dongol AS, Shrestha A, Chawla CD: POSTPARTUM HEMORRHAGE: prevalence morbidity & management pattern in Dhulikhel hospital: Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 212-215

2. Khan KS, Wojdyla d, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of cause of maternal death: a systematic review. Lancet.2006;367:1066-74

3. Pradhan P, Thapa Magar S, Lama S. Post partum haemorrhage in Teaching Hospital. NJOG. 2006; 1(1):26-9.

4. Ronsmans C, Graham WJ. Maternal Mortality: Who, when, where and why? Lancet.2006;368:1189-2000.

5. Fatemeh Hoveyda, IZ MacKenzie; Secondary postpartum hemorrhage: incidence morbidity & current management; BJOG, VOL 108 ISSUE 9, pages 927-930 , september 2001

6. TY Khong & TK Khong: delayed postpartum hemorrhage: A morphologic study of cause & Their relation to other pregnancy disorders; Obstet & Gyaecol1993;82:17-22

7. P.A. King MRCOG, S.J. Duthie MRCOG, Dip Ven,  Z.G. Dong MD, H.K. Ma FRCOG; Secondary postpartum hemorrhage: ANZJOG vol 29 issue4 pages 394-398. nov 1989

8. Ober WB,Grady HG: Subinvolution of placental site; New York Academy of Medicine bulletin; vol37 no10 pages 713-730 octo ber 1961

9. Moir JC. Post partum haemorrhage In: Moir, JC, editor. Munro Kerr’s Operative Obstretics. London: Bailliere, Tindall and Cox; 1956.p.854-76.

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