Review of the Aetiology and Complications of Primary Postpartum Haemorrhage following vaginal delivery at University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria: A 5-year Review.

Abstract

Primary postpartum haemorrhage (PPH) is a major emergency in obstetric practice. It is a major contributor to obstetric haemorrhage and maternal mortality in developing countries. Review is therefore necessary to determine the magnitude and to find ways to reduce this obstetric catastrophe. The objective was to determine the incidence, aetiology and complications of primary PPH among women with vaginal delivery in our center. All the case records of patients that had primary PPH following vaginal delivery over a 5-year period were retrieved and analyzed. A total of 12,966 deliveries were recorded over the period and vaginal delivery accounted for 9,053 of the deliveries. Primary PPH was recorded in 594 of all vaginal deliveries giving the prevalence of 6.6% of total vaginal deliveries. Majority of the women with PPH were grandmultiparous (7.0%); advanced age (35-39years) (9.1%); no formal education (23.6%) and unbooked (10.3%). Uterine atony was the commonest cause of PPH (63.6%) followed by genital tract laceration (19.2%) and retained products of conception (13.8%). The common complications were postpartum anaemia (65.5%), hypovolaemic shock (13.4%) and sepsis (2.3%). Maternal mortality was recorded in 1.1% of women with primary PPH who delivered vaginally. Some risk factors for primary PPH are modifiable and the complications are largely preventable. Identification of patients at risk during pregnancy and labour with prompt intervention to prevent blood loss is advocated. Integrated efforts to prevent occurrence through family planning to prevent grandmultipara and active management of third stage of labour to reduce maternal morbidity and mortality are needed.

Keywords: Postpartum Haemorrhage, Maternal Mortality, Anaemia, Genital Tract Laceration, Shock, Nigeria.