Maternal mortality related to postpartum hemorrhage: a case-control study at the Befelatanana maternity of Madagascar

Abstract

Background: Postpartum hemorrhage (PPH) remains the main cause of maternal death throughout the world. present goal was to determine the associated factors to maternal death in postpartum hemorrhage.Methods: This was a retrospective case-control study; carried out within Befelatanana maternity, in Antananarivo, from January 1st, 2013 to December 31st, 2015, on parturients who presented PPH. The cases were represented by the parturients who died despite well-managed care, and the control, by the living parturients.Results: Authors recorded 181 cases of PPH from 20,888 deliveries, with a prevalence of 0.86%; 47 of them died and 134 were alive; the mortality rate by PPH is 25.96%. Factors associated with death were low education (p=0.00 OR:3.2), non-working (p=0.01, OR:2.4), multiparity ( p:2.2 OR:0.01), absence of prenatal care (p:0.01 OR:2.2), cesarean section (p:0.00 OR:5.5); Intrauterine Fetal Death (p= 0.02, OR:2.2); uterine atony (p=0.03, OR 2.1); the state of shock (p=0.00 OR:57.8), sanitary evacuation (p=0.01 OR: 2.4), the need for blood transfusion (p=0.00 OR: 3, 7), use of catecholamines (p=0.00, OR:17.5); delayed management (p=0.01, OR:2.2), hemostasis hysterectomy (p=0.00 OR: 8.67).Conclusions: The decrease of maternal mortality related to PPH requires better monitoring of pregnancy, delivery and postpartum. Speed care management, improvement of technical platform and establishment of a powerful health system are also needed. Thus, the global reduction of poverty is indispensable.

Maternal Deaths due to Obstetric Hemorrhage in Padang, Indonesia: A Case-Control Study

“…Our study is in concordance 16,10 but the study conducted showed otherwise. 11 We did not fi nd any signifi cant association 68 Omari, Yusrawati and Yenny Indones J Obstet Gynecol between the birth attendant and maternal deaths due to hemorrhage. The present study found almost all deliveries of dead women who were already in high-risk pregnancy and severe conditions assisted by healthcare workers.…”

“…This fi nding is in line with a study in Madagascar and Turkey that showed 70.2% and 50.68% of all deaths due to haemorrhage were caused by uterine atony, respectively. 10,11 However, previous studies have shown varying results. In North-East India, uterine atony only occurs in around 15.98% of females.…”

“…This result is similiar to fi ndings in previous studies in Madagascar, Senegal, and Mali. 11,16 Indications for cesarean section are already risk factors for hemorrhage from delivery. 11 Another literature fi nds that caesarian delivery caused greater amount of blood loss compared to spontaneous delivery.…”

“…11,16 Indications for cesarean section are already risk factors for hemorrhage from delivery. 11 Another literature fi nds that caesarian delivery caused greater amount of blood loss compared to spontaneous delivery. In caesarian delivery, diagnosis and prevention to further blood loss are needed, so that danger to mother's life can be averted.…”

“…Our study is in India and Madagascar. 18,11 Women who had routine antenatal check-ups can identify the risk factors of pregnancy such as age, parity, pregnancy intervals, anemia status, history of illness, previous labour history, and PPH history. The place of delivery needs to be discussed and planned according to the risk of PPH identifi ed during antenatal care.…”