Incidence, risk factors, treatment and outcomes of postpartum hemorrhage at a district hospital in Zambia

Abstract

Background and Objectives

  Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide; 99% of maternal deaths due to PPH occur in developing countries. The aim of this study was to analyze the current status and trend of PPH at a district hospital in Zambia.

Methods

  All women who delivered at Zimba Mission Hospital, a district hospital covering a population of 98,000, in 2017 were included in this retrospective survey. The incidence, risk factors, treatment, and outcomes of PPH were analyzed. PPH was defined as blood loss ≥ 500 ml within 24 h after vaginal delivery or ≥1,000 ml within 24 h after cesarean section. Data were extracted from admission, delivery, and operation registers. Risk factors were identified by multivariable logistic regression analysis.

Results

  Among the 1,704 women who delivered at the hospital, PPH developed in 107 (6.3%) women. Risk factors for PPH after vaginal delivery were assisted vaginal delivery (adjusted odds ratio [aOR], 14.40; 95% confidence interval [CI], 6.72-30.80), macrosomia (aOR, 5.19; 95% CI, 1.69-15.90), and multiple pregnancy (aOR, 4.04; 95% CI, 1.37-11.90). Risk factors for PPH after cesarean section were placenta previa (aOR, 13.20; 95% CI, 2.37-73.10) and parity ≥ 3 (aOR, 9.85; 95% CI, 3.50-27.70). Sufficient oxytocin was administered in all cases. Advanced treatment was required in 19 (17.8%) cases. Balloon tamponade was performed successfully in 7 (6.5%) cases. B-Lynch uterine compression suturing was performed successfully in 2 (1.9%) cases. Hysterectomy was performed in 10 (9.3%) cases, and 2 (1.9%) women died after the operation.

Conclusions

  The incidence of PPH was slightly higher than estimated global incidence. Different risk factors for PPH were identified between vaginal deliveries and cesarean sections. Most of the patients survived after advanced treatment.