To Study the Factors Associated With Post Partum Haemorrhage and Management of Post Partum Haemorrhage at a Tertiary Health Care Centre of Rural India - A Cross-Sectional Study

Abstract

Background: Postpartum hemorrhage (PPH) is one of the most critical and life-threatening obstetric emergencies, capable of transforming an otherwise uncomplicated delivery into a fatal event. If left untreated, severe hemorrhage can result in rapid maternal death, even in previously healthy women. Among the four stages of labor, the third stage is particularly crucial, as it is during this period that the most dreaded complication - PPH may arise. Affecting approximately 2% of all women who give birth, PPH accounts for nearly one-quarter of all maternal deaths globally and remains the leading cause of maternal mortality in many low-income countries, including India

Aim and Objectives: 1. To identify and analyze the factors associated with postpartum haemorrhage (PPH) and to evaluate the management practices of PPH at a tertiary health care center in rural India.2.To study the most common factor associated with postpartum haemorrhage (PPH).3. To determine maternal outcomes and complications associated with PPH

Methodology: Study Design: A cross-sectional observational study.

Study Setting: Labor ward, Obstetrics and Gynaecology department, at a GMC Gondia.

Study Population: Women admitted at the tertiary care hospital with obstetric haemorrhage.

Study Period: 18 months, May 2023 to October 2024

Sample Size: 89

Results: Majority of the study subject belonged to the age group of less than 25 years, i.e. 48 out of 89 cases Majority of study subjects belonged to lower middle-class family i.e. 66 out of 89 cases (74.1%), Majority of study subjects were primigravida i.e.29 out of 89 cases (32.6%), Majority of study subjects belonged to more than 37 weeks 60 out of 89 cases, The most common high-risk factor associated with postpartum heamorrhage was anaemia i.e. 26 out of 89 cases (29.2%), followed by pregnancy induced hypertension i.e. 23 out of 89 cases (25.8%). There were 13 cases of abruptio placenta, 17 cases of grand multi para, 11 cases of previous LSCS, 7 cases of multiple gestation, 12 cases of prolonged labour, 5 cases of placenta previa, 5 cases of thrombocytopenia, vaginally delivery 61, LSCS 28, main type of PPH was atonic, seen in total 58 out of 89 cases (65.1%), Majority of the patients were managed by blood transfusion for correcting anaemia, i.e. 80 out of 89 cases (89.9%), also by pharmacological agents 88 cases out of 89 (98.9 %) i.e. with 20-40 units of Pitocin, and other uterotonic drugs like carboprost and methergine, and 18 cases out of 89 cases (20.2%) were managed conservatively with ballon tamponade. 28 cases surgically managed.

Conclusions: Postpartum hemorrhage continues to be the leading cause of maternal mortality worldwide. Postpartum hemorrhage can be managed effectively by early and timely diagnosis followed by proper monitoring of high-risk cases and active management of third stage of labour with use of uterotonics like oxytocin, misoprostol, Carboprost and methergine and blood transfusions whenever indicated and skillful surgical while in some cases surgical intervention may be required.