Management and Prognosis of Early Postpartum Hemorrhage in African Low Setting Health

Abstract

Early postpartum hemorrhage is one of the major causes of maternal death in the world especially in developing countries. Its management often relieves resuscitation that is often difficult to set up in our countries and sometimes based on invasive and mutilate surgery. Objectives: The purpose of this survey was to report frequency of this pathology, to describe its management and the factors that influence the prognosis of early postpartum hemorrhage in low setting health in Africa. Method: Authors conducted a prospective study that analyzed early postpartum hemorrhage in the motherhoods of Gabriel Touré teaching hospital and community five health reference center of the district of Bamako. It took place from January, 2015 to December, 2016. The study concerned all the cases of early postpartum hemorrhage according to WHO definition. Statistical tests used were X 2 or Fisher test, its 95% confidence interval (CI 95% ), p value was significant if <5%. Results: Early postpartum hemorrhage frequency has been 0.7% (62 cases for 8.885 deliveries). Sixty nine and one percent (69.1%) of patients have been blood fluid transfused. Obstetric treatment dominated by uterine revision (30.7%). Hysterorraphy (4.0%), hysterectomy (3.0%), suture of uterus injuries (15.7%), hypo gastric artery ligature (2.0%) and B-Lynch compression suture (2.0%) have been the main practiced surgical operations. No satisfy blood transfusion need was 26.9%. The main risk factors of early PPH were high parity (p = 0009; RR = 3.04; CI 95% [2.80 -5.11]), prolonged labor (p = 0004; RR = 4.00; CI 95% [3.06 -10.02]), oxytocin/prostaglandin use (p = 0003; RR = 1.47; CI 95% [1.17 -3.16]). Eleven of maternal occurred (11.8%). Conclusion: Early postpartum hemorrhage is still a severe event in developing countries especially. Its management sometime consisted to invasive cares. Maternal prognosis that is influenced by unsatisfied blood need and late management is marked by high lethality.

Prevalence and predictors of primary postpartum hemorrhage: An implication for designing effective intervention at selected hospitals, Southern Ethiopia

“…Complications during labor was found to be predictors of primary postpartum hemorrhage. Similar to what was found in a studies conducted in Cameroon, Zimbabwe, Côte D’Ivoire and Ethiopia [7, 10, 23, 24]. This may be explained by the fact that the study hospitals are referral centers.…”

“…Primary postpartum hemorrhage may develop in patients with no risk factors [15, 16]. However, there have been a number of previous studies attempting to identify predictors of postpartum hemorrhage in different countries include previous PPH [7, 17], multiple pregnancy [17, 18], pre-partum anemia [5, 11, 19], large baby [18, 19], placenta praevia [20, 21], induction of labor [22, 23], prolonged labor [10, 23, 24], operative vaginal delivery [5, 19], delivery by Caesarean section [18, 22], preeclampsia [10, 17], mothers age 35 or above years [18, 26], multiparity [23, 24, 26], post term pregnancy[3] and chorioamnionitis[6].…”

Risk factors for postpartum haemorrhage in the Northern Province of Rwanda: A case control study

“…A growing body of literature has investigated predictors of PPH in different countries. These predictors include: previous PPH [ 10 , 18 – 20 ], mother’s age 35 years or above [ 19 – 22 ], hypertensive disorders in pregnancy [ 7 , 10 , 22 , 23 ], prolonged labour or complication during labour [ 7 , 20 , 24 , 25 ], operative vaginal delivery and instrumental vaginal deliveries [ 20 , 26 , 27 ], multiparity [ 21 , 24 , 25 ], multiple pregnancy [ 10 , 19 ], Hb less than 10gr/dL on admission to labour, ante-partum anaemia [ 23 , 26 – 28 ], fundal height of 38cm or above or large baby [ 19 , 23 , 26 ], placenta praevia [ 29 , 30 ] and induction of labour [ 25 , 31 ].…”

Investigating and modelling risk factors for primary postpartum haemorrhage among childbearing Women in the Northern Province of Rwanda: A Case Control Study

“…A growing body of literature has investigated predictors of PPH in different countries. These predictors include: previous PPH [9,[17][18][19], mother's age 35 years or above [18][19][20][21], hypertensive disorders in pregnancy [6,9,21,22], prolonged labour or complication during labour [6,19,23,24], operative vaginal delivery and instrumental vaginal deliveries [19,25,26], multiparity [20,23,24], multiple pregnancy [9,18], Hb less than 10gr/dL on admission to labour, ante-partum anaemia [22,[25][26][27], fundal height of 38cm or above or large baby [18,22,25], placenta praevia [28,29] and induction of labour [24,30].…”