Prevalence of and factors associated with post-partum hemorrhage following cesarean section among mothers delivering at Kawempe National Referral Hospital, Uganda

Abstract

Background: Postpartum hemorrhage is one of the leading causes of severe maternal morbidity and mortality; accounting for 27.1% of maternal deaths worldwide, ranging from 8% in developed countries to 32% in Northern Africa. In Uganda, postpartum hemorrhage accounts for 34% of the maternal deaths. Despite being a treatable and preventable condition, the high number of maternal deaths resulting from postpartum hemorrhage has remained a significant worldwide concern. This study aimed to establish the prevalence and factors associated with PPH following cesarean section among mothers delivered from Kawempe National Referral hospital. Methods: This was a cross sectional study conducted at Kawempe National Referral Hospital. A total of 247 participants (women of reproductive age group 15-49 years) were recruited using systematic sampling and following attainment of informed consent. Study period from 1 st December 2023-30th January 2024. PPH was defined as blood loss of >1000mls during or after cesarean delivery or any amount of bleeding that led to hemodynamic instability characterized by shock index > 0.7 or hemorrhage that necessitated blood transfusion, hemostatic sutures (O’Leary, Cho and B lynch) or hysterectomy. Data was collected using a pretested interviewer-administered questionnaire, entered in EpiData version 7.1.2, cleaned, and exported to Stata v15 for analysis. Results: Among the 247 mothers that were recruited into the study, the average age was 27.98 (±5.64). Majority were Baganda (46.6%), 93.1% were married and 49.0% had attained secondary education. The prevalence of PPH among post caesarean section mothers was found to be 18.2% with Atony accounting for 73.3%, coagulation disorders (17.8%), trauma (13.3%) and retained tissue (8.8%). PPH following C/section was found to be significantly associated with anaemia during pregnancy (aOR=5.212, 95% CI 1.713 - 15.855, P-Value 0.004), history of pre-eclampsia (aOR=3.803, 95% CI 1.403 - 10.311, P-value 0.009) and increase in shock index > 0.7 (aOR=75.506, 95% CI 10.424 - 546.937, P-Value <0.001). Conclusion: Mothers with anemia and hypertensive disorders should be identified during antenatal and optimized to minimize intrapartum complications. In the event of pre or intra operative diagnosis, management should be tailored to account for the risk of massive intraoperative bleeding and a multidisciplinary team alerted and prepared to minimize morbidity and/or mortality