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OBJECTIVE: To determine the frequency, causes and outcome of postpartum haemorrhage (PPH) at Liaqat Memorial Hospital (LMH) Khyber Medical University Institute of Medical Sciences (KIMS), Kohat, Pakistan.

METHODS: This descriptive study was conducted on diagnosed patients of PPH admitted in labour room of LMH, KIMS, Kohat, Pakistan. Data regarding mode of delivery, management and outcome of PPH was collected from January 2011 to December 2015. The blood loss measurement was subjective. The standard criterion for PPH definition and classification was used.  The data was analysed via SPSS-21.

RESULTS: Out of 46266 deliveries during the study period, documented PPH cases were 1453 (3.14%). The most common cause of PPH was atonic uterus (n=566; 38.95%), followed by genital tract trauma (n=489; 33.7%). Primary PPH was seen in 1408 (96.9%) cases. Out of 1453 cases of PPH, 993 (68.34%) had C/section, 330 (22.71 %) were delivered vaginally and 130 (8.95%) had abdominal delivery for ruptured uterus. Conservative medical management was done in 535 (36.82%) patients; repair of various kinds of tears was done in 489 (33.65%) patients and subtotal abdominal hysterectomy in 198 (13.63%) cases. Nine (0.62%) patients had disseminated intravascular coagulation (DIC), 7 (0.48%) patients had ruptured bladder along with ruptured uterus, 5 (0.34%) patients had renal failure and 3 (0.21%) patients developed pulmonary edema. Thirty five (2.41 %) patients died due to PPH.

CONCLUSION: In all the observed patients of PPH, atonic uterus and genital tract trauma were the main causes while DIC and ruptured uterus were main complications of PPH.

KEY WORDS: Postpartum Haemorrhage (MeSH), Uterine Inertia (MeSH), Atonic uterus (Non-MeSH), Uterine Rupture (MeSH), Disseminated Intravascular Coagulation (MeSH),  Maternal Mortality (MeSH), Subtotal abdominal hysterectomy (Non-MeSH)



Department of Reproductive Health and research, World Health Organization (WHO). WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva: WHO; 2012. [Cited on: February 22, 2017]. Available from URL:

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol 2006 Oct; 108(4):1039-47.

PDHS, National Institute of Population Studies & Demographic and Health Surveys. Pakistan Demographic and Health Survey. 2006–2007. [Cited on: February 22, 2017]. Available from URL:

Landy HJ, Laughon SK, Bailit JL, Kominiarek MA, Gonzalez-Quintero VH, Ramirez M, et al. Characteristics associated with severe perineal and cervical lacerations during vaginal delivery. Obstet Gynecol 2011; 117:627–35. DOI: 10.1097/AOG.0b013e31820afaf2.

Sheikh L, Najmi N, Khalid U, Saleem T. Evaluation of compliance and outcomes of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in Pakistan. BMC Pregnancy Childbirth 2011;11(1):28. DOI: 10.1186/1471-2393-11-28.

Bibi S, Danish N, Fawad A, Jamil M. An audit of primary post partum haemorrhage. J Ayub Med Coll Abbottabad 2007;19(4):102–6.

Hoveyda F, MacKenzie IZ. Secondary postpartum haemorrhage: incidence, morbidity and current management. Br J Obstet Gynaecol 2001; 108(9):927–30.

AbouZahr C. Global burden of maternal death and disability. Br Med Bull 2003;67:1–11.

Weeks A. The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next? Br J Obstet Gynecol 2015 Jan; 122(2):202-10. DOI: 10.1111/1471-0528.13098.

Munir SI, Sadiq A, Ishtiaq S. Frequency of causes of primary postpartum haemorrhage in a tertiary care hospital. Ann King Edward Med Uni 2015;21(1): 27-32. DOI: 10.21649/akemu.v21i1.692

Gani N, Ali TS. Prevalence and factors associated with maternal postpartum haemorrhage in Khyber Agency, Pakistan. J Ayub Med Coll Abbottabad 2013;25(1-2):81–5.

Edhi MM, Aslam HM, Naqvi Z, Hashmi H. Postpartum hemorrhage: causes and management. BMC Res Notes 2013 Jun 18;6:236. DOI: 10.1186/1756-0500-6-236.

Mousa HA, Blum J, Abou El Senoun G, Shakur H, Alfirevic Z. Treatment for primary postpartum haemorrhage. Cochrane Database Syst Rev 2014;(2):CD003249]. DOI: 10.1002/14651858.CD003249.pub3.

Alexander J, Thomas P, Sanghera J. Treatments for secondary postpartum haemorrhage. Cochrane Database Syst Rev 2002;(1):CD002867. DOI: 10.1002/14651858.CD002867.

Calvert C, Thomas SL, Ronsmans C, Wagner KS, Adler AJ, Filippi V. Identifying Regional Variation in the Prevalence of Postpartum Haemorrhage: A Systematic Review and Meta-Analysis. PLoS One 2012;7(7):e41114. DOI: 10.1371/journal.pone.0041114.

Sheldon WR, Blum J, Vogel JP, Souza JP, Gülmezoglu AM, Winikoff B, et al. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. Br J Obstet Gynecol 2014 Mar;(121 Suppl 1):5-13. DOI: 10.1111/1471-0528.12636.

Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol 2008 Dec;22(6):999-1012. DOI: 10.1016/j.bpobgyn.2008.08.004.

Humza S, Saeed S, Ali H, Parkani GM, Kasi Z. Various presentations and management of primary postpartum haemorrhage at BMCH , Quetta, Pakistan. Rawal Med J 2017;42(1):68-72.

Korejo R, Nasir A, Yasmin H, Bhutta S. Emergency obstetric hysterectomy. J Pak Med Assoc 2012 Dec;62(12):1322-5.

Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United States, 1994-2006. Am J Obstet Gynecol 2010;202(4):353.e1-6. DOI: 10.1016/j.ajog.2010.01.011.

Duhan L, Nanda S, Sirohiwal D, Dahiya P, Singhal S, Vandana. A retrospective study of maternal and perinatal outcome in patients of postpartum haemorrhage in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol 2016 Jun;5(6):1897-901 DOI: 10.18203/2320-1770.ijrcog20161686

Kabiru WN, Jamieson D, Graves W, Lindsay M. Trends in operative vaginal delivery rates and associated maternal complication rates in an inner-city hospital. Am J Obstet Gynecol 2001;184(6):1112-4. DOI: 10.1067/mob.2001.115178

Caughey AB, Sandberg PL, Zlatnik MG, Thiet MP, Parer JT, Laros RK Jr. Forceps compared with vacuum: rates of neonatal and maternal morbidity. Obstet Gynecol 2005;106(5 Pt 1):908-12. DOI: 10.1097/01.AOG.0000182616.39503.b2

Khooharo Y, Yousfani JZ, Malik SH, Amber A, Majeed N, Malik NH, et al. Incidence and management of rupture uterus in obstructed labour. J Ayub Med Coll Abbottabad 2013 Jan-Jun;25(1-2):149-51.

Alam I, Khan A, Ahmed R, Begum N. A two Year Review of Uterine Rupture at Gynaecology Unit-A Ayub Teaching Hospital. J Ayub Med Coll Abottabad 2000;12(2):21-2.

Aziz S. Indication of Emergency Hysterectomy in Pakistani Patients. J Soc Obstet Gynaecol Pak 2017;7(1):45-9.

Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: A WHO systematic analysis. Lancet Glob Health 2014;2(6):e323–33. DOI: 10.1016/S2214-109X(14)70227-X

Naz H, Sarwar I, Fawad A, Nisa AU. Maternal morbidity and mortality due to primary PPH--experience at Ayub Teaching Hospital Abbottabad. J Ayub Med Coll Abbottabad 2008 Apr-Jun;20(2):59-65.

Wanderer JP, Leffert LR, Mhyre JM, Kuklina EV, Callaghan WM, Bateman BT. Epidemiology of obstetric-related ICU admissions in Maryland: 1999–2008. Crit Care Med J 2013;41(8):1844–52. DOI: 10.1097/CCM.0b013e31828a3e24.

Qureshi R, Irfan Ahmed S, Raza A, Khurshid A, Chishti U. Obstetric patients in intensive care unit: Perspective from a teaching hospital in Pakistan. J Royal Soc Med Open 2016;7(11):1–8. DOI: 10.1177/2054270416663569

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