Various Presentations and Management Of Primary Postpartum Haemorrhage (Pph) At A Tertiary Care Hospital

Abstract

Objective: To evaluate the various presentations and management of primary postpartum haemorrhage (PPH) at a tertiary care hospital.

Methodology: This descriptive study was conducted over six months in the Department of Obstetrics & Gynaecology, Shaikh Zayed Women Hospital, Larkana. A total of 123 women aged 20–40 years who developed primary PPH within 24 hours of delivery were included. Patients with intrauterine fetal death, chronic medical illness, or gestational age <28 weeks were excluded. Data regarding demographic characteristics, causes, and management of PPH were recorded on a predesigned proforma and analyzed using SPSS version 26. Quantitative variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages.

Results: The mean age was 27 ± 3.2 years. Most patients 93 (75.5%) were between 36–40 weeks of gestation. Multiparous women constituted 82 (66.6%), and 54 (44%) were un-booked. Uterine atony was the leading cause of PPH in 79 (64.2%) cases, followed by retained placental tissue in 20 (16.2%). Vaginal wall ulceration was observed in 9 (7.3%) patients, while cervical tear, retained placenta, and perineal tear were each noted in 4 (3.2%) cases. Hysterectomy was performed in 54 (43.9%) patients. Manual removal of placenta was done in 22 (17.8%), and repair of perineal and cervical tears in 21 (17%) cases. Medical management alone was sufficient in 8 (6.5%) patients.

Conclusion: Uterine atony is the most common cause of primary PPH. The high rate of hysterectomy highlights delayed presentation and limited use of conservative measures. Improved antenatal care and timely management may reduce morbidity and the need for radical interventions.