Massive postpartum haemorrhage as a cause of maternal morbidity in a large tertiary hospital

Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology
S HazraJ C Konje

Abstract

All cases of massive PPH (defined as estimated blood loss > 1500 ml within 24 hours of delivery) were identified from the obstetric database of the unit for the period 1997-2001 (inclusive). The casenotes of the patients were retrieved and various variables collected for analyses. Over the 5-year period, there were 145 cases of massive PPH of the 27,106 deliveries; an incidence of five per 1000 deliveries (0.5%). Most (42%) of the women were nulliparous and 12 (8%) had four or more previous deliveries. There was associated antepartum haemorrhage in 12 (8%) cases, five of which were placental abruptions. Risk factors identified to be associated with massive PPH included prolonged labour, emergency caesarean section (CS) for failure to progress, especially in the second stage (34), and placenta praevia (10). Four women had an abdominal hysterectomy. Massive PPH remains an important cause of severe maternal morbidity; risk factors, which are independent of parity, include CS in the late first stage or second stage and previous CS (irrespective of parity). A high index of suspicion is necessary for these cases, as timely intervention is more likely to minimise the complications and its consequences.

References

May 2, 2000·Baillière's Best Practice & Research. Clinical Obstetrics & Gynaecology·J Bonnar
May 5, 2001·BMJ : British Medical Journal·M WaterstoneC Wolfe
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Citations

Feb 4, 2006·Clinical Obstetrics and Gynecology·Catalin S Buhimschi, Irina A Buhimschi
Feb 10, 2010·Clinical Obstetrics and Gynecology·Massimo FranchiniGiuseppe Lippi
Aug 22, 2008·BJOG : an International Journal of Obstetrics and Gynaecology·I Al-ZirqiB Stray-Pedersen
Nov 8, 2006·Journal of Thrombosis and Haemostasis : JTH·B CharbitUNKNOWN PPH Study Group
Oct 4, 2011·Anesthesia and Analgesia·Jerrold H LevyRoman M Sniecienski
Jun 8, 2013·Obstetrics and Gynecology·Andrew J DillaMark H Yazer
Feb 18, 2012·The Cochrane Database of Systematic Reviews·Olufemi T OladapoEdgardo Abalos
Dec 19, 2014·Blood·Jerrold H Levy, Lawrence T Goodnough
Aug 7, 2012·Acta Obstetricia Et Gynecologica Scandinavica·Vedran StefanovicMinna Tikkanen

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