Postpartum Hemorrhage Affects 1.17% of Deliveries in Ethiopian Hospital, with 6.6% Mortality Rate

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality worldwide, particularly devastating in resource-limited settings where access to timely and effective care is often constrained. Understanding the local epidemiology of PPH, including its prevalence, specific characteristics, and outcomes, is critical for developing targeted interventions and improving maternal health strategies. Current global guidelines for PPH management exist, but their implementation and effectiveness vary significantly, necessitating regional data to identify specific challenges and gaps in care. This study addresses this need by providing a detailed snapshot from a tertiary hospital in northern Ethiopia.

This retrospective descriptive study analyzed data from 23,090 deliveries recorded at Ayder Comprehensive Specialized Hospital in Tigray, northern Ethiopia, between January 1, 2017, and December 31, 2021. Researchers identified 269 cases diagnosed with postpartum hemorrhage (PPH), excluding 12 incomplete charts. The study collected and analyzed sociodemographic, obstetric, and clinical characteristics, along with management strategies and patient outcomes, using descriptive statistics. Key management interventions reviewed included the use of non-pneumatic anti-shock garment (NASG), misoprostol, oxytocin, and ergometrine, as well as surgical interventions like laparotomy and hysterectomy.

Over the 5-year period, postpartum hemorrhage (PPH) occurred in 269 cases out of 23,090 deliveries, yielding a prevalence of 1.17% (95% CI 0.027-1.30), equivalent to 11 per 1000 deliveries. Primary PPH, occurring within 24 hours of delivery, constituted 220 (85.6%) of known cases, with 53.7% diagnosed within 2 hours. The documented mean blood loss was substantial at 1,572.9 ml (SD = 914.3). Patients experienced a significant drop in hemoglobin, from a mean of 12.2 mg/dl before PPH to 7.8 mg/dl after.

Management strategies included misoprostol in 144 (56%) cases, oxytocin in 125 (48.6%), and non-pneumatic anti-shock garment (NASG) in 79 (30.7%). Surgical intervention was frequent, with laparotomy performed in 59 (23%) cases, leading to hysterectomy in 40 (67.8%) of those. Adverse outcomes were notable: organ dysfunction (specifically renal failure) in 34 (13.2%) cases, coagulation dysfunction in 14 (5.4%), and 17 (6.6%) maternal deaths. Additionally, 7 (3.1%) cases required admission to the intensive care unit (ICU).