Prevalence, related factors and maternal outcomes of primary postpartum haemorrhage in governmental hospitals in Kabul-Afghanistan

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Abstract

Background

To determine the prevalence, related factors and maternal outcomes of primary PPH in governmental hospitals in Kabul Afghanistan.

Methods

An observational study was designed to determine the prevalence, related factors and maternal outcomes of primary PPH in governmental hospitals in Kabul-Afghanistan. The population of this study consisted of all women who gave birth to a child between August and October 2018. The structured checklist was used to collect the data from patients who were suffering from primary PPH.

Results

Among the 8652 women who were observed, 215 (2.5%) of them suffered from primary PPH and 2 (0.9%) of them died under caesarean section. The most common related factors of primary PPH were uterine atonia (65.6%), previous PPH (34.9%), prolonged labor (27%), genital tract trauma (26.5%), and induction of labor (20.5%). The most common maternal outcomes of primary PPH were respiratory failure (7%), hysterectomy (6%), and hypovolaemic shock (5.1%).

Conclusions

According to our findings, the major cause of postpartum bleeding was uterine atonia. Therefore, postpartum care of women is essential, especially for those with previous PPH and prolonged labor that require more attention.

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Most cited references 21

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Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health.

W R Sheldon, J Blum, J P Vogel … (2014)

To explore the clinical practices, risks, and maternal outcomes associated with postpartum haemorrhage (PPH). Secondary analysis of cross-sectional data. A total of 352 health facilities in 28 countries. A total of 274 985 women giving birth between 1 May 2010 and 31 December 2011. We used multivariate logistic regression to examine factors associated with PPH among all births, and the Pearson chi-square test to examine correlates of severe maternal outcomes (SMOs) among women with PPH. All analyses adjust for facility- and country-level clustering. PPH, SMOs, and clinical practices for the management of PPH. Of all the women included in the analysis, 95.3% received uterotonic prophylaxis and the reported rate of PPH was 1.2%. Factors significantly associated with PPH diagnosis included age, parity, gestational age, induction of labour, caesarean section, and geographic region. Among those with PPH, 92.7% received uterotonics for treatment, and 17.2% had an SMO. There were significant differences in the incidence of SMOs by age, parity, gestational age, anaemia, education, receipt of uterotonics for prophylaxis or treatment, referral from another facility, and Human Development Index (HDI) group. The rates of death were highest in countries with low or medium HDIs. Among women with PPH, disparities in the incidence of severe maternal outcomes persist, even among facilities that report capacity to provide all essential emergency obstetric interventions. This highlights the need for better information about the role of institutional capacity, including quality of care, in PPH-related morbidity and mortality. © 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

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Risk factors for severe postpartum hemorrhage: a case-control study

Lill Trine Nyfløt, Irene Sandven, Babill Stray-Pedersen … (2017)

Background In high-income countries, the incidence of severe postpartum hemorrhage (PPH) has increased. This has important public health relevance because severe PPH is a leading cause of major maternal morbidity. However, few studies have identified risk factors for severe PPH within a contemporary obstetric cohort. Methods We performed a case-control study to identify risk factors for severe PPH among a cohort of women who delivered at one of three hospitals in Norway between 2008 and 2011. A case (severe PPH) was classified by an estimated blood loss ≥1500 mL or the need for blood transfusion for excessive postpartum bleeding. Using logistic regression, we applied a pragmatic strategy to identify independent risk factors for severe PPH. Results Among a total of 43,105 deliveries occurring between 2008 and 2011, we identified 1064 cases and 2059 random controls. The frequency of severe PPH was 2.5% (95% confidence interval (CI): 2.32–2.62). The most common etiologies for severe PPH were uterine atony (60%) and placental complications (36%). The strongest risk factors were a history of severe PPH (adjusted OR (aOR) = 8.97, 95% CI: 5.25–15.33), anticoagulant medication (aOR = 4.79, 95% CI: 2.72–8.41), anemia at booking (aOR = 4.27, 95% CI: 2.79–6.54), severe pre-eclampsia or HELLP syndrome (aOR = 3.03, 95% CI: 1.74–5.27), uterine fibromas (aOR = 2.71, 95% CI: 1.69–4.35), multiple pregnancy (aOR = 2.11, 95% CI: 1.39–3.22) and assisted reproductive technologies (aOR = 1.88, 95% CI: 1.33–2.65). Conclusions Based on our findings, women with a history of severe PPH are at highest risk of severe PPH. As well as other established clinical risk factors for PPH, a history of severe PPH should be included as a risk factor in the development and validation of prediction models for PPH.

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Postpartum hemorrhage: epidemiology, risk factors, and causes.

Yinka Oyelese, Cande V. Ananth (2010)

Postpartum hemorrhage (PPH) is a leading cause of death and morbidity relating to pregnancy. Uterine atony is the leading cause of PPH, and trauma, including iatrogenic trauma, increases the risk for postpartum hemorrhage. Women with PPH in a pregnancy are at increased risk of PPH in a subsequent pregnancy. Awareness of these facts, and anticipation and prevention of uterine atony, as well as avoiding unnecessary cesareans, episiotomies, and other genital tract trauma have the potential to significantly reduce the mortality and morbidity from postpartum hemorrhage. The epidemiology of postpartum hemorrhage, including the incidence and temporal trends as well as the causes and risk factors associated with it are presented.

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Author and article information

Contributors

Adela Nazari: adela.nazari@yahoo.com

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 28 July 2020

Publication date PMC-release: 28 July 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 428

Affiliations

[1 ]GRID grid.411705.6, ISNI 0000 0001 0166 0922, Reproductive health department, School of Nursing and Midwifery, , Tehran University of Medical Sciences, ; P.O. Box 6459, Tehran, Iran

[2 ]GRID grid.442859.6, ISNI 0000 0004 0410 1351, Midwifery department, School of Nursing and Midwifery, , Kabul Medical University, ; Kabul, Afghanistan

[3 ]GRID grid.411705.6, ISNI 0000 0001 0166 0922, Reproductive health department, School of Nursing and Midwifery, , Tehran University of Medical Sciences, ; P.O. Box 6459, Tehran, Iran

[4 ]GRID grid.412266.5, ISNI 0000 0001 1781 3962, Department of biostatistics, , Tarbiat Modares University, ; P.O. Box 8288, TMU, Tehran, Iran

[5 ]GRID grid.442859.6, ISNI 0000 0004 0410 1351, Midwifery department, School of Nursing and Midwifery, , Kabul Medical University, ; Kabul, Afghanistan

Author information

Shirin Shahbazi Sighaldeh http://orcid.org/0000-0003-4043-923X

Article

Publisher ID: 3123

DOI: 10.1186/s12884-020-03123-3

PMC ID: 7390104

PubMed ID: 32723320

SO-VID: e9216cb6-7195-4743-ad4b-57f28253b5cb

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 17 February 2020

Date accepted : 21 July 2020

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: observational design,abnormal bleeding,afghanistan women,atony,bleeding,hemorrhage

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: observational design, abnormal bleeding, afghanistan women, atony, bleeding, hemorrhage

Prevalence, related factors and maternal outcomes of primary postpartum haemorrhage in governmental hospitals in Kabul-Afghanistan

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Advocacy for Maternal and Women’s Health

Most cited references 21

Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health.

Risk factors for severe postpartum hemorrhage: a case-control study

Postpartum hemorrhage: epidemiology, risk factors, and causes.

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