How to Cite



Objectives; To estimate the prevalence of postpartum hemorrhage (PPH) and identify its associated factors among the married women of 15-49 years, residing in the Karachi, Pakistan.

Methodology: This cross-sectional survey was carried out in five squatter settlements of Karachi during 2000-2001. Information was collected regarding age, gravida, education, antenatal, natal and postnatal care, with perceived puerperal morbidities from 525 mothers, who were in their 42nd to 56th post delivery day. Univariate and multivariate analyses were computed using multiple logistic regression method.

Results: The estimated prevalence for perceived PPH was 7.24%. Three hundredand ninety six (75.4 %) women received ante-natal care with 273 (52%) consulting skilled health professionals and 268 (51%) gave birth to their babies at a health facility. Eighty nine (16.9%) women who delivered at a health facility were advised for the post partum routine care and only 127 (24.2%) women followedthe instructions. Two hundred and seventy eight (53%) mothers reported at least one perceived puerperal morbidity and among them 38 (7.24%) women perceived PPH. On multivariate analysis, the factors associated with PPH were older age (aOR=1.10, 95% CI:1.04-1.1), longer duration of labor (aOR=1.08, 95% CI :1.02-1.2) and restricted fluid intake (aOR=2.1, 95% CI :1.05-4.0).

Conclusion: Older age group, longer duration of labor and restricted fluid intakewere found to be the common factors associated with PPH. Women need to be educated regarding family planning program, safe and timely delivery by skilled medical personnel and intake of extra fluid during post partum period.

Key Words: Prevalence, Postpartum Hemorrhage, Duration of Labor.



Li XF, Fortney JA, Kotelchuck M, Glover LH. The postpartum period: the key to maternal mortality. Int J Gynaecol Obstet 1996; 54(1): 1-10.

Ronsmans C, Graham WJ. Maternal mortality:

who, when, where, and why. The Lancet. 2006; 368(9542): 1189-200.

Koblinsky MC, Harlow S. Mother and More. Newyork: Churchill; 1994.

Mousa HA, Alfirevic Z. Treatment for primary

postpartum haemorrhage. Cochrane database syst Rev. 2007; 1.

Royal College of Obstetricians and Gynecologists.

Prevention and management of postpartum haemorrhage. Green-top Guideline No. 52; May 2009.

Alexander J, Thomas P, Sanghera J. Treatments

for secondary postpartum haemorrhage.

Cochrane Database Syst Rev. 2002;

Carroli G, Cuesta C, Abalos E, Gulmezoglu

AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Practice & Research Clinical Obstetrics and Gynaecology 2008; 22: 999-1012.

World Health Organization. Attending to136 million births, every year: make every mother and child count: The world Report 2005. Geneva, Switzerland: WHO, 2005. p. 62-3.

Safe motherhood. Postpartum care of the mother and newborn: a practical guide.Geneva: Maternal and newborn health / safe motherhood unit, division of reproductive health (technical support), WHO; 1999.

Jabeen M, Gul F, Rahman M. Maternal mortality ratio and its causes in a district headquarter hospital of NWFP. J Postgrad Med Inst 2005; 19(4): 377-81.

Refaey HE, Brien PO, Morafa W, Walder J, Rodeck C. Use of oral misoprostol in the prevention of postpartum haemorrhage. Br J Obstet Gynecol 1997; 104: 336-339.

Feerasta SH, Motiei A, Motiwala S, Zuberi NF. Uterine atony at a tertiary care hospital in Pakistan: a risk factor analysis. J Pak Med Assoc. 2000 Apr; 50(4): 132-6.

Jabeen S, Ahmed A, Bhatti S-U-Z, Zaman BS. Maternal mortality. The Professional Med J 2010; 17: 679-85.

Aziz-Karim S, Memon AM, Qadri N. Grandmultiparity: a continuing problem in developing countries. Asia Oceania J Obstet Gynaecol. 1989 Jun; 15(2): 155-60.

Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PFA. WHO analysis of causes of maternal death: a systematic review. The Lancet 2006; 367: 1066-1074.

WHO. WHO Recommendations for the prevention of postpartum haemorrhage. Geneva: World Health Organization; 2009.

Ali TS, Fikree FF, Rahbar MH, Mahmud S. Frequency and determinants of vaginal infection

in postpartum period: a cross-sectional

survey from low socioeconomic settlements, Karachi, Pakistan. J Pak Med Assoc. 2006; 56(3): 99-103.

Wood AJJ, Goldberg AB, Greenberg MB, Darney PD. Misoprostol and pregnancy. New Eng J Med 2001; 344(1): 38-47.

Shaikh BT, Hatcher J. Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers. Journal of Public Health. 2005; 27(1): 49-54.

Pakistan Social and Living Standards Measurement Survey (PSLM) 2006-07 Provincial / District. (retrieved on March 22, 2013).

World Health Organization. Population and Health: Safe motherhood pregnancy is special- Lets make it safe. 1998.

United Nations International Children Emergency Fund (UNICEF). State of the World’s Children 2000.

De Silva WI. Puerperal Morbidity: A neglected area of Maternal Health in Sri Lanka. Soc Biol 1998; 45(3-4): 223-245.

Le Ray C, Fraser W, Rozenberg P, Langer B, Subtil D, Goffinet Fo. Duration of passive and active phases of the second stage of labour and risk of severe postpartum haemorrhage

in low-risk nulliparous women. Europ J Obstet Gynecol Reproduct Biol 2011; 158(2): 167-72.

Saunders NS, Paterson CM, Wadsworth J. Neonatal and maternal morbidity in relation to the length of the second stage of labour. Br J Obstet Gynaecol. 1992; 99(5): 381-5.

Janni W, Schiessl B, Peschers U, Huber S, Strobl B, Hantschmann P, et al. The prognostic

impact of a prolonged second stage of labor on maternal and fetal outcome. Acta Obstet Gynecol Scand. 2002 Mar; 81(3): 214-21.

Khan B, Khan B, Sultana R, Bashir R, Deeba F. A ten year review of emergency peripartum hysterectomy in a tertiary care hospital. J Ayub Med Coll Abbottabad. 2012; 24(1): 14-17.

Naib JM, Siddiuqi MI, Jehangir S. The role of Prostaglandins in the Mangement of Primary

Post-Partum Haemorrhage Due to Uterine Atony/Hypotony and the Impact of their use on the need for obstetrical hysterectomy. J Postgrad Med Inst 2004; 18(2): 153-61.

El Refacy H, O’Brien P, Morafa W, Walder J, Rodeck DC. Use of oral misoprostol in the prevention of postpartum hemorrhage. Br J Obstet Gynecol 1997; 104: 336-339.

Tsu VD. Postpartum haemorrhage in Zimbabwe:

A risk factor analysis. Br J Obstet Gynaecol. 1993; 100(4): 327-33.

Ijaiya MA, Aboyeji AP, Abubakar D. Analysis

of 348 consecutive cases of primary postpartum haemorrhage at a tertiary hospital in Nigeria. J Obstet Gynaecol. 2003 Jul; 23(4): 374-7.

Myles MF. Textbook for Midwives: with modern concept of Obstetric and Neonatal

care. 8th ed. New York: Churchill Livingstone; 1975.

Ayello EA, Thomas DR, Litchford MA. Nutritional

aspects of wound healing. Home Healthcare Nurse. 1999; 17(11): 719-29.

Work published in KMUJ is licensed under a

 Creative Commons Attribution-NonCommercial 2.0 Generic License.

Creative Commons License

Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.