Primary post partum hemorrhage: outcome of different treatment measures

This study was carried out to compare the efficacy and safety of different therapeutic measuresused for controlling primary postpartum haemorrhage (PPH). The venue of this work was theDepartment of Obstetrics and Gynaecology Lady Willingdon Hospital Lahore over a period ofsix months from July 1, 2005 – December 31, 2005. Fifty patients of primary PPH wererecruited in this study. After identifying the risk factors for primary PPH thorough history,examination and investigations, these patients were treated medically and surgically to controlhaemorrhage. Control of bleeding by different measures was secured for the survival ofpatients. Medical intervention included use of oxytocins, and prostaglandins. Different surgicalprocedures like manual removal of placenta, suturing of genital tract tears, bimanual uterinecompression and packing, stepwise devascularization and caesarean hysterectomy were done.Results of different procedures were analysed by using research proforma. The results showthat out of fifty, fifteen (30%) were booked patients. The major predisposing factor was grandmultiparity in twenty-five (50%) patients. The predominant cause was uterine atony in thirty(60%) cases. Twenty (66%) patients were completely cured by different oxytocins. Eight (16%)had manual removal of placenta and two (4%) required evacuation of retained products ofconception. Nine (18%) were treated by suturing the tears and lacerations. The commonestmorbidity (66%) was anaemia. Mortality rate was 6%. In conclusion there is a need to reducethe alarmingly high maternal mortality and morbidity caused by primary PPH. Its mainpredisposing factors should be controlled. High parity, illiteracy and ignorance coupled withinadequate maternity services contribute towards this tragedy. If patients reach hospital well intime, effective management of obstetric haemorrhage should be prompt restoration ofcirculatory volume, accurate diagnosis of the cause of bleeding and early appropriate therapyto arrest the bleeding