Primary PPH What Worsen Maternal Outcome?

Research Article

Austin J Womens Health. 2022; 9(1): 1064.

Primary PPH What Worsen Maternal Outcome?

El Khateeb R* and Kamal M

Department of Obstetrics and Gynecology, Minia University, Egypt

*Corresponding author: Reham El Khateeb, Assistant Professor, Department of Obstetrics and Gynecology, Minia University, Egypt

Received: September 06, 2022; Accepted: October 19, 2022; Published: October 26, 2022


Objective: The aim of the study was to explore factors that worsen maternal outcome (maternal morbidity and mortality) in cases developed Primary Postpartum Hemorrhage (PPH).

Methodology: Cross sectional observational study carried out during the period from July 2016 till June 2017, 387 cases were recruited in the study from those who developed 1ry PPH. All data concerning cases were recorded including personal, obstetric, medical history, details of medical services received, complications and maternal mortality. Analysis of data recorded was done to determine factors associated with worse maternal outcome (morbidity and mortality).

Results: 387 cases developed 1ry PPH (either managed in or referred) to hospitals of Minia Governorate (two secondary hospitals and one tertiary hospital) during the period of the study. 87 cases were excluded due to incomplete records. 1y PPH was common in MG 53% , residents’ rural areas 63.7%, patients not booked for ANC 59.7% and anemic patients 67.9%. Bivariate correlation of factors that worsen maternal outcome showed positive correlation between maternal complications and maternal age, parity, residence (rural areas), distance between residence and hospital (far), positive history of medical problems (anemia), blood transfusion and number of blood units. Maternal complications developed in 13.3%, coagulopathy was the most common 37.5%. 9 cases developed maternal mortality (3%) most common cause of death was irreversible shock 44.4%.

Conclusion: Factors that worsen the maternal outcome in patients who developed primary PPH are residence in rural areas, decrease awareness of ANC importance, high parity, advanced maternal age, prevalence of anemia and decrease number of well qualified hospitals.

Keywords: PPH; Risk factors; Maternal morbidity and mortality.

Trial Id: ACTRN12616000632493


1ry: Primary; PPH: Postpartum Haemorrhage; MG: Multigravida; ANC: Antenatal Care; BMI: Body Mass Index; HIV: Human Immunodeficiency Virus


Post-partum haemorrhage is defined as the loss of 500 ml of blood or more after vaginal birth or the loss of at least 1,000 ml of blood after a caesarean delivery within first 24 hours of delivery [1]. Post-partum haemorrhage has been a nightmare for obstetricians since centuries, it is a leading cause of maternal mortality worldwide. There are 600,000 maternal deaths reported worldwide every year and 99% of these occur in developing countries, among them 25% of deaths in developing world are due to PPH [2], however another study reported 27.1% of maternal death due to PPH [3].

Globally, maternal mortality contributes a major health problem, particularly in developing countries where more than 50 % of maternal deaths occurred and where the lifetime risk of maternal death is 10 times higher than that in high-income countries [4]. The global total number of maternal deaths decreased by 43 % from 532,000 in 1990 to 303,000 in 2015. The global Maternal Mortality Ratio (MMR) declined by 44 %, from 385 maternal deaths per 100,000 live births in 1990 to 216 in 2015—an average annual decline of 2.3% [5]. The goal 5a of the Millennium Development Goals (MDGs) calls for the reduction of maternal mortality by 75 % between 1990 and 2015 [6].

In Egypt, postpartum hemorrhage is one of the leading causes of maternal morbidity and mortality. The maternal mortality ratio declined from 84 deaths per 100,000 live births in 2000 to 54 deaths in 2009 then to 52.5 in 2013 [7], but has plateau since then. About 20% of maternal deaths nationwide are due to postpartum hemorrhage [8].

The estimated total cost to treat one patient with PPH amounts to roughly 730 Egyptian pounds (£E). Labor contributes 7% to this total; laboratory tests 18%; and drugs, supplies and materials (including blood products) 75%. For 2013, the estimate that the direct costs to the Egyptian health system were about £E20.5 million to treat an estimated 28,000 cases of PPH, however, the actual total cost, including indirect costs, may be £E40 million or more [8].

Postpartum hemorrhage lead to serious maternal morbidity include cardiovascular complication, respiratory, renal, coagulation, hepatic, neurological, uterine hazards [9].

A better understanding of the factors associated with maternal morbidity and mortality related to PPH would help health care providers to rapidly identify women at highest risk for dying and provide appropriate care in preventing PPH and help care providers to strengthen both diagnosis and treatment of PPH among women at high risk.


This study is a cross-sectional observational survey study. It was carried out at hospitals of Minia Governorate (Maternity hospital of Minia university, Minia General hospital and Misr Al-horra hospital), Egypt. It was carried out during the period from July 2016 till June 2017..A total of 387 women developed PPH and managed in or referred to those hospitals were recruited in the study but 87 patients were excluded due to incomplete records.

Ethical Approval

Study was approved by ethical committee of Minia university faculty of medicine on 2/6/2016. It was registered in ANZCTR (ACTRN12616000632493).

Informed consent was taken from cases or their relatives before recruitment in the study.

Cases distribution per hospital were as follow:

Maternity hospital of Minia University (191 cases).

Minia General hospital (total number 144 cases) 46 were excluded and 98 were recruited.

Misr Al-Horra hospital (total number 52 cases) 41 were excluded and 11 were recruited.

Inclusion criteria: All women developed primary PPH

Exclusion criteria: Women with incomplete data collection during labor or postpartum period.

All data about the cases were recorded including: personal history, demographic characters, obstetricaldata, medical data, data related to medical services received, maternal complications and maternal mortality due to PPH.

Statistical Analyses

All statistical analyses were performed using Statistical Package for Social Science (SPSS) version 21 under windows 7 operating system. Results are expressed as means ± SD for quantitative data and by No. (%) for qualitative data. Comparisons between groups were conducted by Student’s t test for parametric data and by Mann Whitney test for Non-parametric data. Chi-Square test was used to test the significance between categories regarding qualitative data.

Bivariate correlation and regression analyses were done to determine factors associated with maternal morbidity and maternal mortality related to primary PPH.

Probability level (P-value) was assumed significant if less than 0.05 and highly significant if P-value was less than 0.01. P-value was considered non-significant if greater than or equal to 0.05.


See Figure 1 and Tables 1-5.