Primary Postpartum Haemorrhage in Lagos, Nigeria
Context: Postpartum haemorrhage (PPH) remains a significant cause of maternal mortality worldwide, necessitating this study to determine the magnitude in a developing country. Objective: To determine the frequency, risk factors, mode of management and outcome of primary postpartum haemorrhage (PPH) in a Nigerian obstetric population. Study Design, Setting and Subjects: A case-control study done in a University Teaching Hospital in Nigeria. Data was extracted from the delivery register and individual case records over a five-year period in two groups of women. One group consisted of those with primary PPH following vaginal delivery (Study Group) and the other consisted of consecutive women who delivered the same day but without PPH (Control Group). Main Outcome Measures: Frequency of occurrence and sources of PPH, delivery outcome and complications. Results: There were 298 patients with primary PPH, a frequency of 6.6%. Atonic uterus 84 (33.8%), genital tract lacerations 70 (28.2%), episiotomies 61 (24.6%) and retained placenta 32 (13%) were the four leading identifiable causes. Other apparent risk factors for primary PPH were instrumental deliveries, augmented labours, absence of antenatal care and deliveries conducted by senior registrars and midwives. Complications noted included anaemia (i.e. Hb < 11gm/dl/) in 108 patients (36.2%), episiotomy dehiscence in 4 (1.3%) and one maternal death (0.3%). Conclusion: Timely, less liberal episiotomies are advocated. Active management of the third stage of labour should be promoted and there is need to re-appraise the storage and potency of oxytocics available for usage.