Study of Cases of Postpartum Haemorrhage

DR. PRATIK R. BHALODIA; DR. SHITAL T. MEHTA; DR. BABUBHAI S. PATEL; DR. VISMAY B. PATEL; DR. MAULESHKUMAR P. MODI; DR. CHHAYA R. THAKKAR

Volume : III, Issue : X, October - 2014

Study of Cases of Postpartum Haemorrhage

Dr. Pratik R. Bhalodia, Dr. Shital T. Mehta, Dr. Babubhai S. Patel, Dr. Vismay B. Patel, Dr. Mauleshkumar P. Modi, Dr. Chhaya R. Thakkar

Abstract :

INTRODUCTION: PRIMARY PPH is generally defined as any amount of blood loss more than 500 ml from genital track at vaginal delivery, 1000ml at cesarean section or 1500ml at cesarean hysterectomy.12,2 Alternative definitions include a 10% drop in hematocrit13,2 or the need of blood transfusion in first 24 hours after delivery14,2.Third stage hemmorhage occurs before expulsion of placenta and true PPH occurs after expulsion of placenta.. If excessive blood loss occurs after 24 hours but before 6 weeks it is called SECONDARY PPH .The incidence of PPH is 30% among maternal mortality data2.AIMS AND OBJECTIVES: To determine the incidence of PPH, to determine the risk factors for PPH, evaluate the role of obstetrician in preventing PPH, Current protocol of management of PPH, to study maternal mortality and morbidity. MATERIAL AND METHOD: This study includes 100 patients who developed PPH from August 2012 to July 2014 at tertiary centre.Exact amount of blood loss measurement is often difficult in clinical obstetrics due to contamination with amniotic fluid and other excreta and the blood lost on floor or towels ,clothes so blood loss was assessed on the basis of measurement from the basins and blood loss on linens, mops and sponges. In all cases necessary investigations were carried out and managed accordingly. The data collected was analyzed systematically, tabulations were made and observations compared with series present by various foreign and Indian authors. RESULTS AND DISCUSSION: 29% patients belonged to urban category and 71% belonged to rural category.65% were Emergency cases. Incidence of PPH in primiparas is 41%.46% patients of PPH had undergone Cesarean section65% patients developed atonic PPH, 30% developed traumatic, 3% were associated with coagulopathy, 2% were having secondary PPH.35% of patients responded to medical therapy. In 65% patients, Operative intervention was required– in form of uterine artery ligation, Hypo gastric artery ligation, uterine compression suturing, tear suturing, obstetric hysterectomy , manual removal of placenta, reposition of uterus.Maternal mortality was 2%.CONCLUSION: PPH is a potentially life threating complication of both vaginal and cesarean deliveries. As obstetric care improves the incidence of PPH and maternal death drastically reduces. Early anticipation early interventions with proper planning are required to reduce maternal mortality and morbidity in PPH.Early diagnosis of anemia in antenatal period and correction accordingly, during delivery use of prefilled uterotonics, non hasty delivery, active management of third stage of labor having eagle�s eye at blood loss more than 250 ml can prevent maternal mortality and morbidity to such a good extent. To conclude prevention is better than cure.