Maternal clinical outcomes and quality of life after treatment for postpartum hemorrhage at Kawempe National Referral Hospital

Abstract

Background: In sub-Saharan Africa PPH is still a challenge and accounts for 30 % to 50% of maternal deaths (Lancaster et al., 2020). In Uganda the incidence from six health facilities is reported to be 9% and 7.4 %. PPH is associated with massive blood loss and hypovolemia leading to several complications and outcomes that affect the Quality of life. Objective: To assess maternal clinical outcomes and quality of life at 6 weeks among mothers who were treated for postpartum hemorrhage at Kawempe National referral hospital. Methods: A prospective cohort study was conducted among mothers treated for postpartum hemorrhage. Participants were recruited after stabilization in the labor ward, postnatal ward, or High Dependence Unit, completed an interviewer-administered questionnaire and had blood tests Taken. They were reminded to return after six weeks, where a quality-of-life tool was administered, and further blood tests were taken. Data was collected using a Kobo Collect tool. Proportions of impaired renal function and low hemoglobin were calculated, and clinical outcome computed. A modified Poisson regression analysis was used to obtain risk ratios. WHOQOL Brief tool scores were converted to a linear scale and dichotomized to good or poor QOL and frequencies and percentages obtained. Results: Out of 109 participants, 80 were followed up successfully (attrition rate of 26%). Sixty one percent of mothers had a normal or good clinical while 39% had a poor clinical outcome. Mothers 30 years and above had a higher likely hood of having a poor Clinical Outcome compared to mothers younger than 30years. At recruitment, the majority had low hemoglobin (91%), which improved at follow-up to 53%. Those who had low Hb at recruitment were more at risk of poor clinical outcome at follow up as compared to those had normal Hb at recruitment, and those who had reduced eGFR at recruitment were at risk of poor clinical outcome at follow up as compared to those had normal Hb at recruitment. Most women reported an overall good quality of life at 6 weeks postpartum. The Physical domain had the lowest scores in relation to quality of life. Marital status and higher education level were associated with a good quality of life. The psychological domain had significant associations with the hemoglobin levels at 6 weeks. Conclusion and Recommendation: These findings highlight the importance of monitoring and addressing postpartum low hemoglobin levels to improve women's physical and psychological well-being. Key words: clinical outcome, quality of life, treatment for postpartum Hemorrhage.