Background: Primary postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, with primigravida women particularly vulnerable due to physiological inexperience and lack of prior obstetric history. In developing countries like Pakistan, where access to quality maternal care remains inconsistent, understanding the burden and causes of PPH in first-time mothers is crucial for targeted interventions. Objective: This study aimed to determine the frequency of primary postpartum hemorrhage in primigravida women and identify its key contributing factors, with a focus on modifiable obstetric determinants and associated complications. Methodology: A descriptive cross-sectional study was conducted at the Department of Obstetrics and Gynecology, PUMHS Nawabshah, over six months from November 2023 to May 2024. 150 primigravida women who delivered during the study timeframe were included using a non-probability consecutive sampling method. Data were collected using a structured proforma and analyzed using SPSS version 25 to assess frequencies, percentages, and associations between PPH and obstetric variables. Results: Out of 150 participants, 13 women (8.7%) experienced primary postpartum hemorrhage. Significant determinants included prolonged labor (22.6%), uterine atony (25.8%), retained placenta (5%), and genital tract trauma (18.2%). 49% showed combined causes. Although complications such as acute kidney injury, postpartum anemia, lactation suppression, transfusion-related reactions, and maternal mortality were rare, they highlighted the serious risks associated with PPH. Women with PPH generally require longer hospital stays and more intensive postpartum care. Conclusion: The study emphasizes that PPH in primigravida women is significantly associated with preventable and manageable intrapartum factors. These findings underscore the need for improved antenatal screening, skilled intrapartum care, and rapid postpartum intervention. The results have important implications for health policy, including the development of targeted educational strategies for healthcare providers and patients, and reinforce the need for further multi-center research to evaluate context-specific preventive interventions and protocols to reduce PPH-related morbidity and mortality in first-time mothers.
Sakeena et al. (2025) studied this question.