The Prevalence, Associated Factors, Management and Outcomes of Postpartum Hemorrhage Among Women Admitted to Princess Christian Maternity Hospital in Freetown, Sierra Leone: a Retrospective Study.

Abstract

Background: Postpartum Hemorrhage (PPH) is a leading cause of maternal deaths globally and is associated with 73% of all maternal deaths in low-income setting. The number of women who suffer from PPH globally is estimated at 14 million annually, with approximately 99% of the PPH related deaths occurring in low and middle-income countries. In Sierra Leone, PPH is estimated to be associated with 46% maternal deaths annually. In spite of this, the prevalence, management, and burden of PPH in Sierra Leone has not been documented, hence forming the basis of this research. Objective: To determine the prevalence, associated factors, management and outcomes of mothers admitted with postpartum hemorrhage (PPH) in Princess Christian Maternity Hospital between 2014 and 2018. Methodology: The study utilized a cross sectional descriptive study research design. Records of 1,225 patients’ files for patients who were treated at the Princess Christian Maternity Hospital between 2014 and 2018 were retrieved. The collected data was cleaned and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Chi-square analysis and logistic regression tests were used to determine the association of the sociodemographic and clinical factors and PPH. Results: The average age was 25 ±6 years, 935 (77%) were married. The prevalence of PPH was 18%. Bivariate analysis found that, referral case, p <0.0001 (OR =0.2, 95%CI,0.1 – 0.3), previous mode of delivery, p = 0.007, (OR = 0.5, 95% CI,0.3 – 0.6). Mode of current delivery, p <0.0001 (OR = 0.4, 95%CI,0.3 – 0.6), parity, p =0.01, (OR = 1.2, 95%CI,1.1 – 1.6) and presence of obstetric complications, p <0.0001, (OR = 1.3, 95% CI,0.8 – 1.8) were independent factors associated with postpartum hemorrhage. In multivariate analysis, referral cases, p = 0.00, (AOR = 0.2, 95% CI, 0.1 – 0.3), parity p = 0.004, (AOR = 1.3, 95%CI, 1.1 – 1.6), presence of eclampsia, p = 0.019, (OR = 2.3, 95%CI, 1.5, 3.2) and previous PPH, p = 0.014, (OR = 2.0, 95%CI, 1.1, 3.0) were associated with development of PPH. Uterotonic was the first line intervention used in management of PPH among all PPH cases. There was 31% maternal mortality associated with PPH. Conclusion: The prevalence of PPH was 18% is still high with associated 31% mortality rate. It is essential to maintain closer surveillance and monitoring of mothers in the hours immediately following birth to detect and manage excessive blood loss and reduce severe PPH and associated morbidity. Diversification of resources is essential to controlling the high cases of referrals.