Primary Postpartum Hemorrhage, Still a Big Challenge in Developing World (Experience in Tertiary care Hospitals, KSA versus Pakistan)

Background: Postpartum Hemorrhage (PPH) is still the leading cause of maternal mortality and morbidity in developing world inspite of major developments in its prevention and management in 21st century. While working in KSA, author observed a comparatively low frequency of postpartum hemorrhage in Kingdom of Saudi Arabia (KSA) as compared to her past experience in Pakistan where this figure is still very high. This observation led to conduct this study to find out the reasons for this difference. Objectives: The objective of this study is to find out the differences in frequency, risk factors and management options especially cesarean hysterectomy for PPH between KSA and Pakistan. Study Design: Observational study. Place and Duration of Study: One year study (2007) conducted in tertiary care hospitals i.e. Maternity and Children Hospital Buraida (MCH), KSA and Services Hospital Gyne. Unit II, Lahore (SHL) Pakistan. Methods: The sample included all patients who suffered from PPH over study period in both hospitals. The Sample was divided into two groups; Group A included 105 cases of primary PPH out of 8757 deliveries in MCH Buraida.KSA and Group B included 150 cases of primary PPH out of 2064 deliveries in SHL Gyne Unit 2 Pakistan. Data were collected on a structured proforma regarding risk factors, causes and management options of PPH and compared between the two groups. Analysis of Data: Data was analyzed using computer programme SPSS Version 13 for windows and a pvalue of 0.05 taken as statistically significant. Results: Significant difference was found in frequency of primary PPH (1.19% vesus 7.2% ;p-value 0.05) and risk factors for PPH; anemia (10% versus 78%; p-value- 0.05), prolonged labor (0% versus 9%), obstructed labor (0% versus 6%), grand multiparity (28% versus60%) ,injudicious use of oxytocin (0.95% versus 5.3%) and emergency C-section (20% versus 77%; p-value 0.05), low socioeconomic class, transport problems, and frequency of unbooked cases between Group A and B respectively. Comparatively high frequency of cesarean hysterectomy noted in Pakistan as compared to KSA (3.39/1000 versus 0.45/ 1000 deliveries) respectively. Conclusion: The findings suggest that PPH figures in KSA correspond to those of developed world, and of Pakistan resemble to those seen in developing world, but much better than some African countries. It is concluded that PPH is still a big challenge in developing countries. The reason for this difference is poor socioeconomic status, high prevalence of anemia, home deliveries, inadequate transport services and lack of obstetric services at primary health care level.