Risk Factors and Maternal Outcome of Secondary Post Partum Haemorrhage in Rangpur Medical College Hospital. - A one year study

Abstract

Background: Post partum haemorrhage (PPH) is one of the most common causes of maternal mortality worldwide. Primary PPH (which occurs within 24 hours of delivery) has been studied a lot. But data regarding secondary PPH (which occurs 24 hours after delivery upto to 6 weeks post partum) is sparse. Our aim was to find out the risk factors and maternal outcome of secondary PPH. Materials and Methods: A cross sectional analytic study of 32 cases admitted with secondary PPH in Gynae and Obstetric department of Rangpur Medical College Hospital during 1 year study period was carried out. Result: Frequency of secondary PPH was 0.58%. Mean age of the patient was 25.23±2.79 years; 22(69%) patients were multi para; 17 (53%) patients had education up to primary level. Maximum patients [18 (56%)] were from low socio economic status. Mean time of presentation was 13.5±2.78 days after delivery; 14(44%) patients delivered vaginally and 18(56%) patients delivered by caesarean section. Most of the vaginal delivery 9 (28%) were conducted by untrained dai or other family member. Among 32 patients, 31 were referred from outside the Hospital. Retained bits of placenta was the leading cause (15,47%) and caesarean wound dehiscence was the second cause (13,41%); 13 (40%) patients had fever on presentation. All were anemic with mean hemoglobin concentration 7.4±1.4gm and 24 (75%) of them required blood transfusion. Four patients was in shock. Antibiotic was given to all patients. DE&C was done in 15(47%) cases and laparotomy followed by total abdominal hysterectomy was done in 12 cases and repair in 1 case. Among 15 patients who underwent surgical evacuation there was histological evidence of placental tissue in only 6(40%) patients. Conclusion: In present study retained bits of placenta and caesarean wound dehiscence are found as main cause of secondary postpartum hemorrhage So care should be taken during active management of third stage of labour (AMTSL). Choosing appropriate suture material, maintaining personal hygine of patient and sterility of operation theate, using appropriate antibiotic to combat microbials and last but not list improving skillness of surgeon are the key to reduce the rate of secondary PPH. Keyword: AMTSL, Secondary PPH, Retained bits of placenta Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2): 107-112