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BY DR TULIKA JOSHIDR REETA HANSDA (HOD)
DR ANIMA KERKETTA (SPECIALIST)
STUDY OF SECONDARY POSTPARTUM
HEMORRHAGE CASES
INTRODUCTION
Definition : Hemorrhage occuring after 24 hrs of delivery till 6 weeks post partum.
Incidence : ~1% of all deliveries.
AIMS AND OBJECTIVES
To assess prevalence, morbidity and management pattern of secondary postpartum hemorrhage cases in Bokaro General Hospital.
MATERIALS AND METHODS
Retrospective analytical study.Inclusion criteria: All patients admitted in LR
& Gynaecology ward of Bokaro General Hospital as secondary postpartum hemorrhage case
Duration of study: January 2006 to January 2010
DATA RECORDED
• Data collected LR birth records & admission records.
• Data recorded was:– Age – Parity – Booking history– Place and mode of delivery– Interval between delivery and bleeding– Hemoglobin at the time of admission– Management
CONTINUED
• Management :– Resuscitation & blood transfusion– Definitive treatment:
• Conservative : uterotonics, antibiotics etc• Surgical :
– Dilatation curettage– Laparotomy with conservative surgery– Laparotomy with radical surgery
• The result was expressed as percentage of cases & mean values were calculated.
The main outcome measures used for analysis were: Cause of secondary PPH Place and mode of delivery Management pattern
RESULTS
Total no. of cases - 24Total number of deliveries in this period -
9551Incidence: 24/9551*1000 = 2.51 per 1000
deliveries
Age distribution of patients
Table showing booking status
Booking status No. of patients Perentage
Booked 6 25%
Unbooked 18 75%
Parity wise distribution
Interval of bleeding from delivery
Mode & place of delivery
45.833%
41.66% 54.67%
CAUSES
Hemoglobin on admission
Age In yrs
Mean Hb:9.37 gm%
MANAGEMENT
Blood transfusions No. of patients percentage
None 6 25%
<2 units 12 50%
>2 units 6 25%
Management pattern
58.33%41.66%
8.33%
4.17%
DURATION OF HOSPITAL STAY
Mean : 4 daysRange : 2- 12 daysRe-admissions: 4 cases
Discussion
Study Incidence
Vaginal deliveries
LSCS Primi Multi
Dongol et al (2010)
3.1/1000 deliveries
84.21% 15.78% 31.57% 68.42%
Fatemeh Hoveyda et al (2001)
6.89/1000 deliveries
88.63% 11.36% 42.42% 57.57%
Ober & Grady (1960)
- VD-45%D&E-42%
3% 23% 77%
Present study
2.51/1000 deliveris
58.33% 41.67% 58.33% 41.67%
Causes
Study Abnormal placentation
Infection
Fatemeh Hoveyda et all(2001)
45.45% 13%
Khong & Khong (1993)
44.37% 4.14%
King et al (1989) 42% 12%
Present study 50% 20.83%
Management
Study Blood transfusions
D&E Major surgery
Fatemeh Hoveyda et al (2001)
17% 56% Hystrectomy-3/132Laparotomy-2/132
King et al (1989)
24% 87% Hysterectomy-2/83
Ober & Grady (1960)
- 54% Hysterectomy 41+5%
Present study
75% 42% Hysterectomy-1/24Laparotomy-2/24
CONCLUSION
Secondary postpartum hemorrhage can result in significant maternal morbidity & if left uncared for or mismanaged it may result in maternal mortality. A proper antenatal care along with institutional deliveries will help in reducing the incidence. Apart from that there is a major necessity of maintaining strict asepsis during the intrapartum procedures.
REFERENCES
1. Dongol AS, Shrestha A, Chawla CD: POSTPARTUM HEMORRHAGE: prevalence morbidity & management pattern in Dhulikhel hospital: Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 212-215
2. Khan KS, Wojdyla d, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of cause of maternal death: a systematic review. Lancet.2006;367:1066-74
3. Pradhan P, Thapa Magar S, Lama S. Post partum haemorrhage in Teaching Hospital. NJOG. 2006; 1(1):26-9.
4. Ronsmans C, Graham WJ. Maternal Mortality: Who, when, where and why? Lancet.2006;368:1189-2000.
5. Fatemeh Hoveyda, IZ MacKenzie; Secondary postpartum hemorrhage: incidence morbidity & current management; BJOG, VOL 108 ISSUE 9, pages 927-930 , september 2001
6. TY Khong & TK Khong: delayed postpartum hemorrhage: A morphologic study of cause & Their relation to other pregnancy disorders; Obstet & Gyaecol1993;82:17-22
7. P.A. King MRCOG, S.J. Duthie MRCOG, Dip Ven, Z.G. Dong MD, H.K. Ma FRCOG; Secondary postpartum hemorrhage: ANZJOG vol 29 issue4 pages 394-398. nov 1989
8. Ober WB,Grady HG: Subinvolution of placental site; New York Academy of Medicine bulletin; vol37 no10 pages 713-730 octo ber 1961
9. Moir JC. Post partum haemorrhage In: Moir, JC, editor. Munro Kerr’s Operative Obstretics. London: Bailliere, Tindall and Cox; 1956.p.854-76.
Thank youThank youOn behalf of -On behalf of -
MothersMothers ....and the Newbornsand the Newborns