Postpartum haemorrhage: various method of management in arural tertiary care hospital

Abstract

Introduction: Post-partum haemorrhage is defined as blood loss from the genital tract, exceeding 500ml within 24hours of vaginal delivery and 1000ml during caesarean section. It is also now a day defined as any blood loss that has a potential to produce or produces hemodynamic instability. Massive obstetric haemorrhage is a major cause of maternal mortality and morbidity worldwide.

Aims and Objectives: Objective of the study is to evaluate the most common etiology and method of management of Postpartum Haemorrhage in a rural tertiary care hospital of SAH &RC.

Materials and Methods: A prospective study was done from June 2017 to June 2018 in Department of Obstetrics and Gynaecology at Adichunchanagiri Institute of Medical sciences, Bellur, Karnataka, India. The study included all cases of normal vaginal deliveries, assisted vaginal deliveries and Caesarean section.

Result: A total of 1877women were delivered. Out of which 923 (49.17%) women delivered vaginally and 954 (50.82%) women delivered through cesarean section. Out of 1877 delivered women, 69 (3.67%) developed PPH. out of 69(3.79%), 66(95.65%) had atonic PPH and 3(4.34%) had traumatic PPH. out of 66 atonic PPH cases 54(81.81%) managed medically. Other modalities were B lynch suture 7(10.6%), Hayman suture 2(3.03%), suction cannula 1(1.51%), internal iliac artery ligation 1(1.51%), peripartum hysterectomy 1(1.51%). Most of the cases have been managed medically.

Conclusion: In an era with availability of excellent uterotonics and active management of third stage of labor even today PPH stands first as the cause of maternal mortality and morbidity.This study highlights the existing variable practices for management of PPH. Haemorrhage associated mortality can be prevented by critical judgment and early intervention.