Start Submission Become a Reviewer

Reading: The occurrence, management and outcomes of post partum haemorrhage in a teaching hospital in...

Download

A- A+
dyslexia friendly

Research Article

The occurrence, management and outcomes of post partum haemorrhage in a teaching hospital in Sri Lanka

Authors:

Malik Goonewardene ,

Teaching Hospital Mahamodara Galle, LK
About Malik
Senior Professor and Head Academic Department of Obstetrics and Gynaecology
X close

Chamari de Silva,

Teaching Hospital, Mahamodara Galle,, LK
About Chamari
Demonstrator, Academic Department of Obstetrics and Gynaecology
X close

Madusha Medawala,

Teaching Hospital, Mahamodara Galle,, LK
About Madusha
Demonstrator, Academic Department of Obstetrics and Gynaecology
X close

Sumali Karunarathna

Teaching Hospital, Mahamodara Galle,, LK
About Sumali
Demonstrator, Academic Department of Obstetrics and Gynaecology
X close

Abstract

Introduction: In Sri Lanka post partum haemorrhage (PPH) accounted for 12.7% of maternal deaths in 2008. In 2009 The Sri Lanka College of Obstetricians and Gynaecologists carried out an in-service training program to reduce maternal morbidity and mortality from PPH.

Objective: To evaluate the occurrence, management and outcomes of PPH in a teaching hospital in Sri Lanka and to identify appropriate remedial measures to improve the outcome of PPH.

Design, Setting and Methods: Criteria based input, process and outcome indicators were used to carry out a clinical audit at the Academic Unit of the Teaching Hospital, Mahamodara Galle from 01 June 2010 to 31 December 2011. Areas where appropriate remedial measures could be adopted to prevent PPH and also improve its outcome were identified.

Results: Of the 61 cases of PPH, 97% were identified by the need for blood or colloid transfusion. Morbidity and severe morbidity due to PPH and severe PPH were approx. 130 times and 50 times more respectively, compared to the deaths from PPH in 2008. PPH following Caesarean section (CS) and instrumental vaginal delivery (IVD) were approx. 1.3 times and 3.5 times higher compared to PPH after normal vaginal delivery. Induction of labour (IOL) or Augmentation of labour (AOL) were the two leading risk factors identified. Genital tract trauma was an underlying cause in 59% of cases. Suboptimal management processes identified included: delayed shifting to the operating theatre, delayed involvement of a specialist, not checking haematological status of the patient prior to discharge from hospital, and poor documentation.

Conclusions: Morbidity due to PPH is far greater than mortality. IVD and CS should be carried out only when indicated and in properly selected cases. Measures should be adopted to prevent or reduce genital tract trauma. Women with IOL and AOL need close monitoring after delivery. The suboptimal management processes identified should be corrected.

DOI: http://dx.doi.org/10.4038/sljog.v34i4.5931

Sri Lanka Journal of Obstetrics and Gynaecology 2012; 34: 144-154

DOI: http://doi.org/10.4038/sljog.v34i4.5931
How to Cite: Goonewardene, M. et al., (2013). The occurrence, management and outcomes of post partum haemorrhage in a teaching hospital in Sri Lanka. Sri Lanka Journal of Obstetrics and Gynaecology. 34(4), pp.144–154. DOI: http://doi.org/10.4038/sljog.v34i4.5931
357
Views
245
Downloads
Published on 15 Aug 2013.
Peer Reviewed

Downloads

  • PDF (EN)

    comments powered by Disqus