PREVENTION OF P.P.H: OXYTOCIN VERSUS MISOPROSTOL

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SHABNAM SHAIKH . NAJMA BANO SHAIKH . SABREENA TALPUR . RAHEELA BALOUCH

ABSTRACT | Full Text Pdf

Objective: To determine the frequency, risk factors, causes, management, morbidity and mortality due to primary postpartum hemorrhage (PPH).

Methodology: This Descriptive study was conducted in department of Obstetrics and Gynaecology Unit II of Liaquat University Of Medical and Health Sciences Hospital, Hyderabad From 1st July 2011 to 31st December 2011.Women who developed primary postpartum hemorrhage after admission or admitted with it, were included in our study. Medical record files of these women were reviewed to find out the cause, risk factors, mode of delivery, any medical or surgical intervention, need of blood transfusions and maternal morbidity or mortality associated with this life threatening problem.

Results: Total 1800 deliveries occurred in 6 month duration. Out of which 93 women were developed primary postpartum hemorrhage, thus representing the frequency of 5..1% or 1 in 46 deliveries. Majority 59(63%) women were young and belong to age group between 25-35 years of age and most of them 46(49.5%) were multigravida. 70 (75%) were un-booked. The most common cause of postpartum hemorrhage was uterine atony. Most cases were referred and delivered at home or private maternity clinics run by Traditional Birth Attendants (TBAs) so they reach in moribund condition. 64(69%) women delivered vaginally. Initially all patients were managed pharmacologically followed by surgical intervention. Cesarean hysterectomy was performed in 4(4.%) cases. Internal Iliac Artery ligation along with hysterectomy performed in 2(2%) cases. Blood transfusion were required in 64(68%) patients. The major maternal morbidities were anemia, acute renal failure, disseminated intravascular coagulation and shock. There were 5 (5.3%) maternal deaths.

Conclusion: Uterine atony was the most frequent reason for postpartum hemorrhage secondary to high parity, abruption placentae, placenta previa, and prolong labour. So timely identification and the management of these factors can reduce this deadly problem.