{"title":"Burden and outcomes of postpartum haemorrhage in Nigerian referral-level hospitals","authors":"Tajudeen Adebayo, Ayodeji Adefemi, Idowu Adewumi, Opeyemi Akinajo, Bola Akinkunmi, David Awonuga, Olufemi Aworinde, Ekundayo Ayegbusi, Iyabode Dedeke, Iretiola Fajolu, Zainab Imam, Olusoji Jagun, Olumide Kuku, Ezra Ogundare, Timothy Oluwasola, Lawal Oyeneyin, Damilola Adebanjo-Aina, Emmanuel Adenuga, Alaruru Adeyanju, Olufemi Akinsanya, Ibijoke Campbell, Bankole Kuti, Babatunde Olofinbiyi, Qasim Salau, Olukemi Tongo, Bosede Ezekwe, Tina Lavin, Olufemi T. Oladapo, Jamilu Tukur, Olubukola Adesina","doi":"10.1111/1471-0528.17822","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>To determine the prevalence of primary postpartum haemorrhage (PPH), risk factors, and maternal and neonatal outcomes in a multicentre study across Nigeria.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>A secondary data analysis using a cross-sectional design.</p>\n </section>\n \n <section>\n \n <h3> Setting</h3>\n \n <p>Referral-level hospitals (48 public and six private facilities).</p>\n </section>\n \n <section>\n \n <h3> Population</h3>\n \n <p>Women admitted for birth between 1 September 2019 and 31 August 2020.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Data collected over a 1-year period from the Maternal and Perinatal Database for Quality, Equity and Dignity programme in Nigeria were analysed, stratified by mode of delivery (vaginal or caesarean), using a mixed-effects logistic regression model.</p>\n </section>\n \n <section>\n \n <h3> Main outcome measures</h3>\n \n <p>Prevalence of PPH and maternal and neonatal outcomes.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of 68 754 women, 2169 (3.2%, 95% CI 3.07%–3.30%) had PPH, with a prevalence of 2.7% (95% CI 2.55%–2.85%) and 4.0% (95% CI 3.75%–4.25%) for vaginal and caesarean deliveries, respectively. Factors associated with PPH following vaginal delivery were: no formal education (aOR 2.2, 95% CI 1.8–2.6, <i>P</i> < 0.001); multiple pregnancy (aOR 2.7, 95% CI 2.1–3.5, <i>P</i> < 0.001); and antepartum haemorrhage (aOR 11.7, 95% CI 9.4–14.7, <i>P</i> < 0.001). Factors associated with PPH in a caesarean delivery were: maternal age of >35 years (aOR 1.7, 95% CI 1.5–2.0, <i>P</i> < 0.001); referral from informal setting (aOR 2.4, 95% CI 1.4–4.0, <i>P</i> = 0.002); and antepartum haemorrhage (aOR 3.7, 95% CI 2.8–4.7, <i>P</i> < 0.001). Maternal mortality occurred in 4.8% (104/2169) of deliveries overall, and in 8.5% (101/1182) of intensive care unit admissions. One-quarter of all infants were stillborn (570/2307), representing 23.9% (429/1796) of neonatal intensive care unit admissions.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>A PPH prevalence of 3.2% can be reduced with improved access to skilled birth attendants.</p>\n </section>\n </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7000,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17822","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bjog-An International Journal of Obstetrics and Gynaecology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/1471-0528.17822","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective
To determine the prevalence of primary postpartum haemorrhage (PPH), risk factors, and maternal and neonatal outcomes in a multicentre study across Nigeria.
Design
A secondary data analysis using a cross-sectional design.
Setting
Referral-level hospitals (48 public and six private facilities).
Population
Women admitted for birth between 1 September 2019 and 31 August 2020.
Methods
Data collected over a 1-year period from the Maternal and Perinatal Database for Quality, Equity and Dignity programme in Nigeria were analysed, stratified by mode of delivery (vaginal or caesarean), using a mixed-effects logistic regression model.
Main outcome measures
Prevalence of PPH and maternal and neonatal outcomes.
Results
Of 68 754 women, 2169 (3.2%, 95% CI 3.07%–3.30%) had PPH, with a prevalence of 2.7% (95% CI 2.55%–2.85%) and 4.0% (95% CI 3.75%–4.25%) for vaginal and caesarean deliveries, respectively. Factors associated with PPH following vaginal delivery were: no formal education (aOR 2.2, 95% CI 1.8–2.6, P < 0.001); multiple pregnancy (aOR 2.7, 95% CI 2.1–3.5, P < 0.001); and antepartum haemorrhage (aOR 11.7, 95% CI 9.4–14.7, P < 0.001). Factors associated with PPH in a caesarean delivery were: maternal age of >35 years (aOR 1.7, 95% CI 1.5–2.0, P < 0.001); referral from informal setting (aOR 2.4, 95% CI 1.4–4.0, P = 0.002); and antepartum haemorrhage (aOR 3.7, 95% CI 2.8–4.7, P < 0.001). Maternal mortality occurred in 4.8% (104/2169) of deliveries overall, and in 8.5% (101/1182) of intensive care unit admissions. One-quarter of all infants were stillborn (570/2307), representing 23.9% (429/1796) of neonatal intensive care unit admissions.
Conclusions
A PPH prevalence of 3.2% can be reduced with improved access to skilled birth attendants.
期刊介绍:
BJOG is an editorially independent publication owned by the Royal College of Obstetricians and Gynaecologists (RCOG). The Journal publishes original, peer-reviewed work in all areas of obstetrics and gynaecology, including contraception, urogynaecology, fertility, oncology and clinical practice. Its aim is to publish the highest quality medical research in women''s health, worldwide.