Primary Postpartum Haemorrhage Following Vaginal Delivery in Ahmadu Bello University Teaching Hospital: A five-year retrospective review

Abstract

Background: Postpartum haemorrhage (PPH) is a leading cause of maternal mortality globally. It is also the most common cause of postpartum maternal morbidity in northern Nigeria. Though its causes are known, regional variations in the causes and risk factors do exist.
Objective: To determine the prevalence, causes, risk factors, and outcome of primary PPH following vagina delivery in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria
Methodology: A retrospective cross-sectional study among women who had primary postpartum haemorrhage after vaginal delivery in ABUTH between 1st January, 2017-31st December 2021. Their case folders were retrieved and information regarding the socio-demographic characteristics; reproductive profile; causes; risk factors and maternal outcome of PPH were obtained using a structured proforma.
Results: The prevalence of primary PPH was 6.35%. The mean age and standard deviation were 29.5±4.6years. About one-third (30.2%) were grand multiparous; 91.2% had singleton pregnancies and 67.2% delivered before term. Only 17.6% had unbooked pregnancies and 55.3% booked in non-tertiary facilities. Uterine atony was the commonest cause (52.3%) while coagulopathy was the least (1.5%). Common risk factors for primary PPH were intrauterine fetal death (27.1%), prolonged labour (19.5%), antepartum haemorrhage (16%), and previous history of PPH (7.3%). Haemorrhagic shock was seen in 16.4%, acute kidney injury in 1.1% and the case fatality rate was 2.3%.
Conclusion: The prevalence of primary PPH following vaginal delivery in this study is lower than the global incidence and uterine atony was the commonest cause. Intrauterine fetal death, prolonged labour, and antepartum haemorrhage were the leading risk factors. Therefore, effective antenatal and skilled intrapartum care are key strategies to address the commonly identified risk factors for primary PPH following vaginal delivery.
Keywords: Primary postpartum haemorrhage, prevalence, risk factors, causes