Near miss and mortality audit of women with postpartum hemorrhage (PPH) in a tertiary care center in North India: a cross-sectional study

Abstract

Objectives: To analyze the medical and social risk factors for maternal mortality and near miss in women with postpartum hemorrhage. Methods: It is a cross sectional study organized in department of obstetrics and gynecology, King George Medical University, Lucknow, India. Five hundred women who developed postpartum hemorrhage (PPH) in the hospital or referred with PPH were enrolled in study. Data was collected by a structured questionnaire which included demographic profile, medical and social risk factors, cause and type of PPH, interventions and management done. Maternal near miss (MNM) cases were identified as per WHO 2009 criteria. Results: Atonic PPH was the commonest type of PPH. Severe anemia (OR-2.35, 95%CI 1.58 – 3.61, p value- 0.001) was significantly associated with maternal mortality. Jaundice (OR-31, 95%CI 9.05-109.4, p value- 0.023), and previous cesarean (OR-2.66, 95%CI 1.22- 5.46, p value- 0.003) were found to be significantly associated with MNM. Social risk factors like lack of awareness (OR-4.63, 95%CI 2.43-8.83, p value <0.001), lack of transportation (OR-7.59, 95%CI 4.48-12.86, p value< 0.001), lack of infrastructure (OR-5.30, 95% CI 3.18- 8.82, p value <0.001) and lack of trained health professional (OR-7.35, 95%CI 4.20-12.60, p value <0.001) were found to be significantly associated with mortality. The near miss to mortality ratio was 1.01:1 Conclusions: Reduction of maternal morbidity and mortality due to PPH needs multipronged approach of improving antenatal services, timely recognition and management of risk factors. Enhancing emergency obstetric services at periphery with better transport and referral will help to reduce preventable deaths from PPH.

Keywords

• maternal health
• postpartum hemorrhage
• social factors