An Observational Study of Management Practices and Maternal Outcome of Postpartum Hemorrhage at a Tertiary Care Center

objective: To study the management practices of postpartum hemorrhage (PPH). Secondary objectives:• To determine the risk factors of PPH.• To study the maternal outcome in PPH. Materials and methods:A 1-year hospital-based observational study was conducted on postnatal women referred to or admitted to the labor room, delivered and diagnosed as cases of PPH from January 2018 to December 2018.Main outcomes measured were vitals at the time of admission and after delivery, risk factors, amount of blood loss, investigations like complete blood count, disseminated intravascular coagulation (DIC) profile, fibrinogen, LFT, and RFT.Management practices, implemented according to hospital protocol to arrest bleeding (including medical measures, surgical measures, or a combination of both), were recorded.Maternal outcomes in the form of morbidity indicators like DIC, acute respiratory distress syndrome (ARDS), acute renal failure (ARF), intensive care unit (ICU) admission, massive blood transfusion, and maternal death were noted.Perinatal outcomes like low birth weight, intrauterine fetal death (IUFD), stillbirth, and neonatal intensive care unit (NICU) admission were recorded.Results: The incidence of PPH in the present study was 1.86%.The most common risk factor for PPH was induction of labor (33.3%), followed by anemia (23.9%) and PIH (23.9%).The majority of women (64.6%) had atonic PPH, and 11.45% of cases had both atonic and traumatic PPH.A total of 97.9% of cases were managed successfully using conservative methods, including medical or surgical procedures, or a combination of both.A total of 7 (7.29%)cases required peripartum hysterectomy.There were 2 (2.08%) maternal deaths, and perinatal deaths were 10 cases (9.52%).Conclusion: Postpartum hemorrhage is the major cause of maternal morbidity and maternal mortality.The most common risk factors for PPH were induction of labor, followed by anemia, PIH, and antepartum hemorrhage.To prevent PPH, active management of the third stage of labor (AMTSL) should be practiced for all delivering women.Medical management proved as effective as surgical management of PPH, but a combination of both medical and surgical procedures prevents the delay and helps to give appropriate care in a short time, and thus reduces morbidity and mortality because of PPH.