Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
INTRODUCTION
Definition : Hemorrhage occuring after
24 hrs of delivery till 6 weeks post partum. Incidence : ~1% of all deliveries.
Gynaecology ward of Bokaro General Hospital as secondary postpartum hemorrhage case Duration of study: January 2006 to January 2010
DATA RECORDED
Data collected LR birth records & admission records.
Data recorded was: Age Parity Booking history Place and mode of delivery Interval between delivery and bleeding Hemoglobin at the time of admission Management
CONTINUED
Management : Resuscitation & blood transfusion Definitive treatment:
Conservative : uterotonics, antibiotics etc Surgical : Dilatation curettage Laparotomy with conservative surgery Laparotomy with radical surgery
The main outcome measures used for analysis were: Cause of secondary PPH Place and mode of delivery Management pattern
RESULTS
Total no. of cases - 24 Total number of deliveries in this period -9551 Incidence: 24/9551*1000 = 2.51 per 1000 deliveries
Booked
25%
Unbooked
18
75%
45.833%
54.67%
41.66%
CAUSES
Hemoglobin on admission
Age In yrs
MANAGEMENT
Blood transfusions None <2 units >2 units No. of patients 6 12 6 percentage 25% 50% 25%
Management pattern
4.17%
8.33%
58.33%
41.66%
Discussion
Study Incidence Vaginal deliveries 84.21% LSCS 15.78% Primi 31.57% Multi 68.42%
6.89/1000 deliveries
88.63%
11.36%
42.42%
57.57%
VD-45% D&E-42%
3%
23%
77%
2.51/1000 deliveris
58.33%
41.67%
58.33%
41.67%
Causes
Study Fatemeh Hoveyda et all(2001) Khong & Khong (1993) King et al (1989) Present study Abnormal placentation 45.45% 44.37% 42% 50% Infection 13% 4.14% 12% 20.83%
Management
Study Fatemeh Hoveyda et al (2001) King et al (1989) Ober & Grady (1960) Present study Blood D&E transfusions 17% 56% Major surgery Hystrectomy3/132 Laparotomy2/132 Hysterectomy2/83 Hysterectomy 41+5% Hysterectomy1/24 Laparotomy2/24
24% 75%
CONCLUSION
Secondary postpartum hemorrhage can result in
significant maternal morbidity & if left uncared for or mismanaged it may result in maternal mortality. A proper antenatal care along with institutional deliveries will help in reducing the incidence. Apart from that there is a major necessity of maintaining strict asepsis during the intrapartum procedures.
REFERENCES
1.
2. 3. 4. 5.
6.
7.
8. 9.
Dongol AS, Shrestha A, Chawla CD: POSTPARTUM HEMORRHAGE: prevalence morbidity & management pattern in Dhulikhel hospital: Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 212-215 Khan KS, Wojdyla d, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of cause of maternal death: a systematic review. Lancet.2006;367:1066-74 Pradhan P, Thapa Magar S, Lama S. Post partum haemorrhage in Teaching Hospital. NJOG. 2006; 1(1):26-9. Ronsmans C, Graham WJ. Maternal Mortality: Who, when, where and why? Lancet.2006;368:1189-2000. Fatemeh Hoveyda, IZ MacKenzie; Secondary postpartum hemorrhage: incidence morbidity & current management; BJOG, VOL 108 ISSUE 9, pages 927-930 , september 2001 TY Khong & TK Khong: delayed postpartum hemorrhage: A morphologic study of cause & Their relation to other pregnancy disorders; Obstet & Gyaecol1993;82:1722 P.A. King MRCOG, S.J. Duthie MRCOG, Dip Ven, Z.G. Dong MD, H.K. Ma FRCOG; Secondary postpartum hemorrhage: ANZJOG vol 29 issue4 pages 394398. nov 1989 Ober WB,Grady HG: Subinvolution of placental site; New York Academy of Medicine bulletin; vol37 no10 pages 713-730 octo ber 1961 Moir JC. Post partum haemorrhage In: Moir, JC, editor. Munro Kerrs Operative Obstretics. London: Bailliere, Tindall and Cox; 1956.p.854-76.
Thank you
On behalf of -
Mothers