నైరూప్య

Emerging trend in the etiology of postpartum hemorrhage in a low resource setting

Chigozie Ozoemena Ifeadike, George Uchenna Eleje, Ugochukwu Stanley Umeh, Emmanuel Ikechukwu Okaforcha

Background: While rates of postpartum hemorrhage (PPH) have continued to rise, it is not clear if the etiology and patterns have changed over time. Anecdotal reports have shown that, other than uterine atony, genital tract laceration is emerging as the chief causes of PPH. Objectives: This was to determine the changing trend in the prevalence, causes and maternal mortality associated with PPH in a low resource setting. Methods: A retrospective cohort study of all parturients that had PPH at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria from January 1st, 2006 to December 31st, 2015 was conducted. Post-partum blood loss was calculated by estimating blood losses in graduated containers and in bed lines and gauze packs. Results: During the period under review, a total of 10,502 deliveries were conducted, out of which 119 women were managed for PPH, giving a prevalence of 1.13%. Sixty-nine (58.0%) had primary PPH and 50 (42.0%) had secondary PPH. The overall leading cause of PPH was retained product of conception in 51 (42.9%). The commonest cause of primary PPH was genital tract laceration in 24 (34.8%) followed by uterine atony in 21 (30.4%). The leading cause of secondary PPH was retained products of conception in 37 (74.0%) cases, whereas its least causes were uterine sub-involution and gestational trophoblastic diseases in 1(2.0%) patient each. There was a significant association between the types of PPH and their risk factors/causes (genital tract laceration, uterine atony, retained product of conception, endometritis and coagulopathy; p<0.05 for all). The majority of the cases of primary PPH (94.6%) survived the condition and 5.4% died. Conclusion: Genital tract laceration has emerged as commonest cause of primary PPH followed by uterine atony, while the leading cause of secondary PPH was retained products of conception. This new trend in etiology warrants further investigation in other regions.