CAUSES AND INCIDENCE RATE OF POSTPARTUM HEMORRHAGE AT KASSALA NEW HOSPITAL, SUDAN

Abdel Aziem A. Ali, AbdAlla A., Elhadi Miskeen

Abstract


Postpartum hemorrhage (PPH) is one of the top five causes of maternal mortality in both high income and low income countries, although the absolute risk of death is much lower in the former than the latter (1 in 100,000 versus 1 in 1000 births) (1).

The incidence of PPH varies widely, depending upon the criteria used to define the disorder. A reasonable estimate is 1 to 5 percent of deliveries (1,2).

The WHO estimate that obstetric hemorrhage complicates 10.55 of all live births in the world (13 795 000 women experiencing this problem in 2000) and 28% of all direct maternal deaths due to hemorrhage (132000 maternal deaths) (3).

The most common definition of PPH is estimated blood loss 500 mL after vaginal birth or 1000 mL after cesarean delivery(4). The inadequacy of this definition was illustrated in studies that assessed blood loss using various objective methods: the mean blood loss reported after vaginal and cesarean deliveries was approximately 400 to 600 mL and 1000 mL, respectively, and clinicians were more likely to underestimate than overestimate the volume of blood lost (4,5).

The risk of dying from postpartum hemorrhage depends not only on amount of blood loss but poverty, woman's  lack decision making, lifestyle and malnutrition are another contributing factors(6) . One of the problems that facing the research is how to measure postpartum hemorrhage with accuracy since there is lacking of accurate and gold standard method. The common errors and remedies in managing postpartum hemorrhage include failure to treat anemia in pregnancy, and delay in recognition, substandard care and lack of skills(7).

According to Sudan Household Health Survey (SHHS 2006),Kassala State has high maternal mortality reaching more than one thousand per 100000 live birth.The main complications during labour and delivery include prolonged labour (31.1 per cent), high fever (30.9 per cent), excessive bleeding (22 per cent) and convulsions (10.2 per cent). PPH inKassala State accounted 7.0 %.( 8)

 

In order to provide the policy makers with evidence-based data we aim to investigate the causes of postpartum hemorrhage, to determine the incidence rate and risk factors and to evaluate the outcome of management of patients presented with or developed postpartum hemorrhage at Kassala New Hospital over one year duration (1st Oct.2007 -30th Nov.2008).


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