Introduction and Need for the study: Postpartum hemorrhage continues to
be one of the leading causes of maternal mortality and morbidity, accounting
for about 19.7% all pregnancy related deaths worldwide . Primary
PPH is typically defined as bleeding from Genital tract of 500 ml or more in
first 24 hours of delivery of baby blood loss of greater than 1000ml following Cesarean
delivery of baby.
The main causes or etiologies of
post partum hemorrhage have traditionally been described as fourfold , giving
the mnemonic 4 T’s ; Uterine atony( Tone), genital tract or surgical trauma
(Trauma), retained placenta or parts of placental tissue(Tissue) and
coagulopathies ( Thrombin). Most studies report Uterine atony or failure of the
uterus to contract after delivery to be main cause of PPH.
Late postpartum hemorrhage is bleeding after 24 hours of delivery of
baby. Severe morbidities associated with PPH include anemia, disseminated
intravascular coagulation, blood transfusion, hysterectomy and renal or liver
failure. Identifiable risk factors are believed to include: a history of prior
PPH, nulliparity, overdistended uterus, placental abnormalities such as
placenta previa or placenta accrete, coagulation abnormalities , anemia,
induction of labor , augmentation of labor and prolonged labor.
Given increasing cesarean section
rates and different risk factors reportedly associated with vaginal and
cesarean births, it is worthwhile considering the outcomes following postpartum
hemorrhage separately for these birth modes
Despite advances in obstetric care,
the condition remains unpredictable and often rapidly progressive. Tertiary
care centres manage a high proportion of high risk pregnancies such as post
partum hemorrhage making it essential to generate specific data. The rising
incidence of Postpartum hemorrhage and very less Indian articles about the
condition makes it essential to study.
The main aim of my study is to
identify the risk factors associated with PPH, maternal outcomes. Additionally
we sought to describe the use of blood transfusions, medical and invasive
management techniques commonly used to manage Data collection procedure : Over a period of 12 months ,all the
pregnant women with greater than 28
weeks period of gestation whose pregnancies are complicated by postpartum hemorrhage
admitted in labor room/ obstetric ward, Intensive care units, Emergency
department of KLE’s Dr. Prabhakar Kore
Hospital, Belagavi will be screened and
included in the study after obtaining informed consent Measure the estimated blood loss or
quantify it via validated method Document vital signs such as blood
pressure , pulse rate , respiratory rate and to note any ongoing signs of hemorrhage Maternal characteristics include
age, gravid, parity, gestational age at delivery , prior history of PPH, mode
of delivery( vaginal or cesarean), any complications in previous delivery Detailed antenatal history and
presenting complaints will be noted The general examination and detailed
obstetrics examination ( uterine tone, presence of retained placental fragments
or clots, presence of genital trauma etc Maternal outcomes to Postpartum hemorrhage
such as need for blood transfusion,
uterotonics, uterine massage ,
surgical intervention) will be taken into accoun Baseline and post hemorrhage
hemoglobin values to be compared Other routine investigations like
Complete blood count, Urine routine and examination, serum thyroid stimulating
hormone, DIPSI, HIV Status, HBsAg status, VDRL Status will be noted.
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