The impact of primary postpartum hemorrhage in "Near-Miss" morbidity and mortality in a tertiary care hospital in North India

Abstract

To assess risk factors, mortality and "near-miss" morbidity in early PPH. Retrospective analysis of 178 women with early PPH (within 24 h of delivery) over 4 consecutive years in a tertiary care hospital in North India. All case sheets of patients identified by labor record registers as having early PPH were reviewed by the same person to identify the actual impact of condition. The data was analyzed by chi-square analysis. Early PPH (loss of blood that caused significant alteration in maternal condition or blood loss 500 in vaginal deliveries or> 1000 cc in cesarean section) was recorded in 178; 90 delivered in hospital (Group-A) and 88 referred after delivery (Group-B) from various peripheral centers, i.e., maternity hospitals, nursing homes, district and community health centers. The maternal mortality ratio during this period was 1049/100,000 (139 deaths/13248 live births; direct maternal deaths = 94). Early PPH accounted for 11/94 direct maternal deaths (11.7%). Of these 11 deaths, 3 were in group A and 8 in group B. "Near-miss" morbidity was higher than mortality (Total 19/178; 5/90 in Group-A and 14/88 in Group-B). Delayed referral and lack of active 3rd stage management in Group-B were responsible for most of the adverse events. Both "near-miss" morbidity and mortality in early PPH reflect the level of obstetric care in the developing world. These need to be reduced by strengthening peripheral delivery facilities, active 3rd stage management and early referral.