Risk factors and quality of management of immediate postpartum hemorrhage in N'djamena mother and child hospital

Abstract

Introduction: Immediate post-partum haemorrhages (IPPH) are the leading cause of maternal mortality in the developing countries as well as in the developed ones. The objective of this study was to improve the management of IPPH.
 Patients and method: Our study was a forward-looking descriptive and analytical on risk factors and management quality of Immediate post-partum haemorrhages in  Gynaecology-Obstetrics Department of Mother and Child Hospital in N'Djamena for six months. Any woman that has recently given birth, developed an IPPH complication and consented to participate to the study has been welcomed. The studied variables were epidemiological, clinical, biological, therapeutics and prognosis and have been analysed through SPSS 18.0 Software. 
Results: A total of 2776 deliveries have been performed during this period and from which 98 cases (3.5%) have developed IPPH complication. The age mean 20-24 (29.6%) was the most concerned. Parity has involved large multiparity with a rate of 43.9% (RR=1.55, p=0,009). Uterine atony, retained placenta and other genital trauma during delivery were the main causes of IPPH with respectively 44.9%; 34.7% and 30.6% of rates. Large multiparity, fetal macrosomia and a history of IPPH in the past would increase the risk of developing IPPH due to uterine atony by 2.8 times (p=0.00); 3.8 (p=0.01) and 2.4 (p=0.04) times respectively. A personal history of abortion in the past would increase the risk of developing IPPH due to retained placenta by 9.4 times (p=0.009). Emergency hysterectomy to stop bleeding has been done in 4.1% of cases. Maternal mortality rate was about 6.1%.
 Conclusion: Large multiparity, fetal macrosomia, primiparity, a history of IPPH as well as an abortion are the main risk factors of developing an IPPH.