TITLE:
Postpartum Hemorrhage: Incidence, Causes and Maternal Outcomes at Muhimbili National Hospital, Tanzania—A Retrospective Descriptive Hospital-Based Study
AUTHORS:
Rafiki Nickson Mjema, Amani Idris Kikula, Furaha August, Fadhlun Alwy Al-Beity, Ali Said, Phineas F. Sospeter, Nasra Batchu, Benjamin Shayo, Damian Jeremiah, Ponsian P. Kunambi, John Somi, Patricia Swai
KEYWORDS:
Postpartum Hemorrhage, Incidence, Causes, Maternal Outcomes and Tanzania
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.13 No.7,
July
27,
2023
ABSTRACT: Worldwide obstetric hemorrhage
remains the leading cause of maternal mortality, accounting for over one quarter of maternal deaths. Over half
of these deaths occur in Sub-Saharan Africa with mortality rates of 500 - 1000
per 100,000 births, compared to approximately 5 - 10 in developed countries. Over decades in Sub
Saharan Africa preventive measures and treatment protocols have been made to reduce maternal mortality caused by PPH. While
rates of postpartum hemorrhage have continued to rise, there is a need to
evaluate if its etiology and patterns have changed over time. Broad Objective: This study aims at describing trends in incidence, causes and maternal
outcomes of Postpartum Hemorrhage at Muhimbili National Hospital for a period
of 7 years. Methodology: This is a retrospective descriptive
hospital-based study that has included all cases of postpartum hemorrhage at Muhimbili
National Hospital, a tertiary hospital in Tanzania from 2014 to 2020. The data
was analyzed using SPSS Version 26 and presented using frequency tables, figures and percentages. The trends of
postpartum hemorrhage over time were determined using chi-square test
and P-value where less than 0.05 was
considered statistically significant. Results: Overall, the incidence of postpartum hemorrhage has been fluctuating over the years with minimum of 1.78%
and maximum of 2.87% with no statistical significance. Out of 1113 enrolled
cases of PPH, 422 (37.9%) were attributed to genital tears followed by uterine atony 285 (25.6%). A statistically
significant increase in linear trend was observed in the postpartum hemorrhage
cases due to uterine atony, uterine rupture and sub analysis on genital tears
(cervical tear). Overall, there was a statistically significant change in trend
of maternal outcomes throughout the years, with a P-value time. Conclusion: The trend in the incidence of postpartum
hemorrhage has been fluctuating over the years during the study period. The
leading cause of postpartum hemorrhage was genital tears, followed by uterine
atony with a significant increase in adverse maternal outcomes over the years.
Continuous health education to medical personnel to improve timely and proper
diagnosis of women in danger of PPH and timely referral, thus improve maternal
morbidity and mortality.