Maternal outcomes in postpartum haemorrhage: a prospective observational study of 100 women at a tertiary referral centre in Kutch, Gujarat

Background: Postpartum haemorrhage is the leading direct cause of maternal death worldwide and the commonest cause of maternal death in India. Outcomes at district-level referral centres serving rural populations are less well described than those at urban teaching hospitals. This study evaluated maternal outcomes in such a setting. Methods: This prospective observational study included 100 women with postpartum haemorrhage at a tertiary referral centre in Bhuj, Gujarat, between April 2024 and October 2025. Demographic profile, aetiology, management and outcome were recorded. A composite severe maternal outcome was defined a priori as obstetric hysterectomy, transfusion of four or more units, or maternal death. Associations were tested using Fisher's exact test. Results: Seventy-four women were unbooked, 68 rural and 54 referred after delivering elsewhere. Mean age was 29.2 years (SD 5.6) and mean parity 3.56 (SD 2.13). Uterine atony was the leading cause (68%), followed by genital tract trauma (19%). Surgical intervention was required in 66%, most commonly uterine packing (30%); hysterectomy in 12%. Blood products were transfused in 80%. Postpartum anaemia was the commonest morbidity (34%). Eight women died (8%). Severe maternal outcome occurred in 17% and was associated with caesarean delivery (27.9% versus 8.8%, p=0.016) and previous caesarean section (35.0% versus 12.5%, p=0.040), but not with anaemia or preeclampsia. Conclusions: Case fatality was substantially higher than in comparable published series. Severe maternal outcome clustered around operative delivery and uterine scar rather than antenatal risk factors, suggesting that reducing the interval to definitive haemorrhage control matters more than antenatal risk stratification in this setting.