Managing Major Early (Primary) Postpartum Haemorrhage in Developing Countries

Abstract

Major primary postpartum haemorrhage continues to top the list of causes of maternal mortality worldwide. Delays in the correction of hypovolaemia, diagnosis and treatment of bleeding disorders and initiation of surgery are preventable factors responsible for majority of the deaths. The situation is worse in the developing countries where more deaths are reported due to poor facilities, lack of manpower and delay in seeking expert management. The clinical state of the patient rather than the amount of blood loss should guide the clinician to the urgency of resuscitation. The first priority is to rapidly correct hypovolaemia with crystalloids and red blood cells. It is probably safer to avoid the use of colloids as it has been found to be associated with an increased risk of maternal death. The use of blood components will depend on platelet count, coagulation tests, haematocrit and fibrinogen concentration. The various medical and surgical management modalities that are useful when there is a poor response to oxytocics are presented. Procedures that are possible in developing countries have been highlighted, with an emphasis on surgical intervention measures that are likely alternatives to hysterectomy. The role of intervention radiology in modern obstetrics is also discussed.


Key Words: Postpartum Haemorrhage, Labour, Maternal Death


[Trop J Obstet Gynaecol, 2003, 20: 144-152]