POST-PARTUM HEMORRHAGE IN DELTA STATE, NIGERIA: A LOGISTIC APPROACH

By

Osuji G.A., Obubu M., Obiora-Ilouno H.O, Okoro, C.N

Presented To

Department of Statistics

ABSTRACT

Postpartum Hemorrhage (PPH) is a leading cause of maternal morbidity and mortality relating to pregnancy especially in less developed and developing countries, as it accounts for about 44,000 - 60,000 death yearly (WHO 1991). This study is designed to extract the risk factor(s) associated with PPH. A  logistic regression analysis was used to develop a model for predicting the likelihood of a patient (mother) developing PPH, significant risk factors associated with PPH were identified and suggestions on ways of reducing  PPH occurrence were made. Risk factors such as Type of delivery, professionals who handled the delivery and maternal age were found to be significantly associated with PPH (p < 0.05), while other risk factors; foetal length, birth weight, head circumference, HIV status, parity e.t.c has p-value > 0.05 and hence not significant.
KEYWORDS: Postpartum Hemorrhage; Maternal Morbidity,  

INTRODUCTION

Traditionally, Postpartum Hemorrhage (PPH) has been defined as blood loss in excess of 500 mL after a virginal birth and over 1000 mL after a cesarean delivery (Andersen et al, 2008). It is considered the leading cause of pregnancy related deaths worldwide, with an estimated 140,000 women dying annually from this complication equating to 1 every 4 minutes (Kramer 1987, WHO 1991). Recently, several industrialized countries including Australia, United Kingdom, Canada and the United States have reported increasing incidence of postpartum hemorrhage, here in Nigeria, a-twelve-year analysis of mortalities in Ilorin Kwara State shows that PPH accounts for over twenty three percent (23.3%) of maternal mortality. (Oguntoyinbo et al 2006). Thus, it remains one of the leading causes of death in Africa. According to WHO (1991), 25% of all maternal mortality are due to postpartum hemorrhage, 99% of which occurs in developing countries. Besides death, PPH also is an important cause of pregnancy-related morbidity. It is well recognized that appropriate obstetric management and access to blood transfusion and, if necessary, hysterectomy, can prevent mortality and severe morbidity once PPH occurs (Luis Keith 2000). Although risk factors and preventive strategies are clearly documented, not all cases are expected or avoidable. Uterine atony is responsible for most cases and can be managed with uterine massage in conjunction with oxytocin, prostaglandins, and  ergot alkaloids. Retained placenta is a less common cause  and requires examination of the placenta, exploration of the uterine cavity, and manual removal of retained tissue. Rarely, an invasive placenta causes PPH and may require surgical management. Traumatic causes include lacerations, uterine rupture, and uterine inversion. Coagulopathies require clotting factor replacement for the  identified deficiency. An international PPH collaborative group met and publish a summary of the recent evidence, as well as recommendations for future surveillance and research. Reasons speculated for the temporal increase include maternal obesity, previous caesarean session, multiple pregnancy and differences in the management of labour. Evidence supporting these possible -