PREVALENCE AND FACTORS ASSOCIATED WITH PRIMARY POSTPARTUM HAEMORRHAGE FOLLOWING EMERGENCY CAESAREAN SECTIONS IN MULAGO HOSPITAL

Abstract

Background: Postpartum hemorrhage (PPH) is among the top 3 causes of maternal mortality with a worldwide prevalence of 6%. In Uganda, PPH was stated to cause 25% of maternal deaths as per roadmap to reduce maternal mortality launched in 2008. It however has a 4 times increased risk in caesarean section (CS) more so if the CS is due to an emergency indication. In Mulago hospital, CS rate has risen from 21.5% (2010) to 29.7% (2016) with 80% being of emergency indications. This may correspond to a rise in PPH occurrence in this special population. Active management of 3rd stage of labor and surgical training programs have been done to lower occurrence PPH but it remains a maternal killer. Objective: To establish the prevalence and risk factors associated with primary PPH following emergency CS done at Mulago National Referral hospital. Methods: This was a retrospective study where we used consecutive sampling to recruit 398 participants who had emergency CS. PPH was determined using the estimated blood loss given by the clinician (≥1000mls) after CS or proxy measures taken to manage PPH including extra need for oxytocin use(>10IU), use of therapeutic dose of misoprostol (≥800ug), need for blood transfusion, use of tranexamic acid or aminocaproic acid, need for repeat laparotomy, hysterectomy or other surgical maneuvers following PPH. Data was collected using a questionnaire and an outcome report form filled using information from the chart as well as interviews with the managing clinicians. It was entered using Epidata version 3.1 and exported to Stata version 14.1 for analysis. The prevalence of PPH was calculated as number of mothers with PPH divided by all mothers who participated in the study. Logistic regression was used to determine the associated risk factors. Results: Prevalence of PPH post emergency CS was 24.9%. A placenta located in the upper uterine segment was protective against PPH OR 0.28 (CI 0.09-0.9). Lack of the surgical operative obstetrics (SOO) training among surgeons and general anesthesia were associated with increased risk of PPH OR 1.72 (CI 1.03-2.89) and OR 12.2 (CI 2.3-64.9) respectively. Conclusions and recommendations: The prevalence of PPH following emergency CS is high and to avert maternal mortality and morbidity, SOO training should be extended beyond training institutions to all healthcare facilities that perform CS. The use of spinal anaesthesia over general anaesthesia should continue to be the preferred option.