STUDY OF SECONDARY POSTPARTUM HEMORRHAGE CASES

BY DR TULIKA JOSHI DR REETA HANSDA (HOD) DR ANIMA KERKETTA (SPECIALIST)

INTRODUCTION
Definition : Hemorrhage occuring after

24 hrs of delivery till 6 weeks post partum. Incidence : ~1% of all deliveries.

AIMS AND OBJECTIVES

To assess prevalence, morbidity and

management pattern of secondary postpartum hemorrhage cases in Bokaro General Hospital.

MATERIALS AND METHODS

Retrospective analytical study. Inclusion criteria: All patients admitted in LR &

Gynaecology ward of Bokaro General Hospital as secondary postpartum hemorrhage case Duration of study: January 2006 to January 2010

DATA RECORDED
Data collected LR birth records & admission records.

Data recorded was: Age Parity Booking history Place and mode of delivery Interval between delivery and bleeding Hemoglobin at the time of admission Management

CONTINUED
Management : Resuscitation & blood transfusion Definitive treatment:

Conservative : uterotonics, antibiotics etc Surgical : Dilatation curettage Laparotomy with conservative surgery Laparotomy with radical surgery

The result was expressed as percentage of cases &

mean values were calculated.

 The main outcome measures used for analysis were: Cause of secondary PPH Place and mode of delivery Management pattern

RESULTS
Total no. of cases - 24 Total number of deliveries in this period -9551 Incidence: 24/9551*1000 = 2.51 per 1000 deliveries

Age distribution of patients

Table showing booking status

Booking status No. of patients Perentage

Booked

25%

Unbooked

18

75%

Parity wise distribution

Interval of bleeding from delivery

Mode & place of delivery

45.833%
54.67%

41.66%

CAUSES

Hemoglobin on admission

Mean Hb:9.37 gm%

Age In yrs

MANAGEMENT
Blood transfusions None <2 units >2 units No. of patients 6 12 6 percentage 25% 50% 25%

Management pattern

4.17%

8.33%

58.33%
41.66%

DURATION OF HOSPITAL STAY

Mean : 4 days Range : 2- 12 days Re-admissions: 4 cases

Discussion
Study Incidence Vaginal deliveries 84.21% LSCS 15.78% Primi 31.57% Multi 68.42%

Dongol et al 3.1/1000 (2010) deliveries

Fatemeh Hoveyda et al (2001)

Ober & Grady (1960) Present study

6.89/1000 deliveries

88.63%

11.36%

42.42%

57.57%

VD-45% D&E-42%

3%

23%

77%

2.51/1000 deliveris

58.33%

41.67%

58.33%

41.67%

Causes
Study Fatemeh Hoveyda et all(2001) Khong & Khong (1993) King et al (1989) Present study Abnormal placentation 45.45% 44.37% 42% 50% Infection 13% 4.14% 12% 20.83%

Management
Study Fatemeh Hoveyda et al (2001) King et al (1989) Ober & Grady (1960) Present study Blood D&E transfusions 17% 56% Major surgery Hystrectomy3/132 Laparotomy2/132 Hysterectomy2/83 Hysterectomy 41+5% Hysterectomy1/24 Laparotomy2/24

24% 75%

87% 54% 42%

CONCLUSION
Secondary postpartum hemorrhage can result in

significant maternal morbidity & if left uncared for or mismanaged it may result in maternal mortality. A proper antenatal care along with institutional deliveries will help in reducing the incidence. Apart from that there is a major necessity of maintaining strict asepsis during the intrapartum procedures.

REFERENCES
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Dongol AS, Shrestha A, Chawla CD: POSTPARTUM HEMORRHAGE: prevalence morbidity & management pattern in Dhulikhel hospital: Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 212-215 Khan KS, Wojdyla d, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of cause of maternal death: a systematic review. Lancet.2006;367:1066-74 Pradhan P, Thapa Magar S, Lama S. Post partum haemorrhage in Teaching Hospital. NJOG. 2006; 1(1):26-9. Ronsmans C, Graham WJ. Maternal Mortality: Who, when, where and why? Lancet.2006;368:1189-2000. Fatemeh Hoveyda, IZ MacKenzie; Secondary postpartum hemorrhage: incidence morbidity & current management; BJOG, VOL 108 ISSUE 9, pages 927-930 , september 2001 TY Khong & TK Khong: delayed postpartum hemorrhage: A morphologic study of cause & Their relation to other pregnancy disorders; Obstet & Gyaecol1993;82:1722 P.A. King MRCOG, S.J. Duthie MRCOG, Dip Ven, Z.G. Dong MD, H.K. Ma FRCOG; Secondary postpartum hemorrhage: ANZJOG vol 29 issue4 pages 394398. nov 1989 Ober WB,Grady HG: Subinvolution of placental site; New York Academy of Medicine bulletin; vol37 no10 pages 713-730 octo ber 1961 Moir JC. Post partum haemorrhage In: Moir, JC, editor. Munro Kerrs Operative Obstretics. London: Bailliere, Tindall and Cox; 1956.p.854-76.

Thank you
On behalf of -

Mothers

....and the Newborns