Various presentations and management of primary postpartum hemorrhage at BMCH, Quetta, Pakistan

Objective: To determine various presentation and management of primary post-partum hemorrhage (PPH) in patients at seen at our institution. Methodology: This Study was carried out at the Department of Obstetrics and Gynecology, Bolan Medical College Hospital, Quetta, Pakistan from January 2013 to January 2014. Patients with Post-partum hemorrhage with age ranging from 21 to 43 years were enrolled. Presentation and management were studied. Results: The study included 120 patients with mean age 32.43 +/- 6.23 years. Mean parity was 4.92 +/- 3.44. Uterine atony was the most common cause of primary PPH (n=64), following by tears of cervix, vagina and perineum (n=28), APH (n=17), uterine rupture (n=10) and eclampsia (n=1). All patients responds well to the medical or surgical treatment except seven (5.83) patient died. Conclusion: Primary PPH was an important cause of maternal mortality. Surgical management must be started timely after failure of first line treatment and be integrated in a global strategy aimed to control hemorrhage. PPH can be prevented by avoiding unnecessary inductions/augmentations of labor, identification of high risk patients and use of active 3(rd) stage management protocol. (Rawal Med J 201;42:68-72)