Prevalence, management and outcomes of postpartum hemorrhage in women delivering in Arua Regional Referral Hospital

Abstract

Postpartum Hemorrhage (PPH) is commonly defined as a blood loss of 500 ml or more within 24 hours after birth(WHO, 2014). Globally, postpartum hemorrhage (PPH) is a leading cause of maternal mortality(Say et al., 2014). The global prevalence of PPH is 6 % (Oyelese&Ananth, 2010) and the highest burden is experienced in low-income countries (Sheldon et al., 2014). It is a major cause of maternal morbidity and mortality, accounting for about one-third of all pregnancy-related deaths in Africa and Asia(Lozano et al., 2012). The magnitude of PPH in sub-Saharan Africa is very high accounting for about 10.5 % the deliveries(Rath, 2011). In Uganda, PPH causes 25 % of all maternal deaths(Sheldon et al., 2014) .The severe morbidities associated with PPH include anemia, disseminated intravascular coagulation, blood transfusion, hysterectomy, and renal or liver failure(Callaghan, Kuklina, & Berg, 2010; Walsh, 2011).Uterine atony, or failure of the uterus to contract after delivery, is the most common cause of PPH(Viteri&Sibai, 2018). The prophylactic administration of a uterotonic has been shown to reduce the incidence of PPH through inducing uterine contractions(Dildy III, 2018). Oxytocin is considered the gold standard for prophylaxis, although ergometrine, methergyne, and misoprostol are also frequently used. When uterine atony occurs, the timely administration of a uterotonic drug is recommended(Dahlke et al., 2015). Uterotonic treatment can help prevent the need for more sophisticated interventions, such as the administration of intravenousfluids, additional drug therapy,bloodtransfusion,and surgical intervention. Other interventions in management of PPH include, normal saline/Ringer’s lactate infusion, clot removal, uterine massage, catheterization, vaginal packing, removal of retained placenta and suture compression. Although PPH occurs in all settings, the majority of maternal deaths as a result of PPH take place in developing countries, of which Uganda is included. This disparity has been attributed to differences in quality of care, including the availability of trained personnel attending deliveries, access to quality uterotonic drugs, and the timely receipt of needed interventions when obstetric emergencies arise(Stanton et al., 2012). In the World Health Organization (WHO) multicountry survey that documented the incidence of maternal morbidity and mortality at health facilities globally, PPH accounted for 27% of all deliveries (Souza et al., 2013). In Uganda specifically, majority of the studies focus on the risk factors associated with PPH(Ngwenya, 2016;Ononge, Mirembe, Wandabwa, & Campbell, 2016), and not much is documented regarding outcomes of PPH. This study therefore aims to determine the prevalence, management and outcomes of PPH in a regional referral hospital in Arua District.