Lhakpa Quendren 

Primary postpartum haemorrhage (PPH) has been one of the leading causes of maternal deaths in the country.

A study on incidence, risk factors and outcome of PPH at JDWNRH show that the incidence of PPH was 1.95 percent between January 2018 and December 2019.

This study selected 542 cases out of 9,221 deliveries between January 2018 and December 2019 at JDWNRH, out of which PPH occurred in 180 cases. The cases include 84 in 2018, of which two were after cesarean delivery and 96 in 2019, including four cases related to cesarean delivery.

PPH is defined as severe bleeding of 500ml or more in 24 hours following a vaginal delivery or 1,000ml or more following cesarean delivery, which is a leading cause of maternal morbidity.

According to the study, 29 percent of women who experienced PPH had received blood transfusion, four percent removed their placenta manually, and three percent had adverse outcomes such as laparotomy/hysterectomy.

All the cases of primary PPH survived the condition.

The common causes of PPH, according to the study, were uterine atony, retained placenta, and perineal and cervical tear.

The risk of primary PPH was found 27 times more among women with genital organ laceration and 18 times higher with retained placenta, accounting for about 20 percent of severe PHH cases.

The researchers say that genital trauma (vaginal and cervical lacerations), uterine rupture, retained placental tissue, and maternal coagulation disorders would also result in PPH.

“It is encouraging that available literature supports the claim that PPH can be prevented and timely treatment of PPH can decrease the associated morbidity and mortality,” the researchers say.

The maternal mortality ratio has significantly decreased from 770 per 100,000 live births in 1984 to 89 per 100,000 live births in 2017. Maternal mortality due to PPH has declined from 45 percent in 2001 to nine percent in 2012.

The PPH in Bhutan is lower compared to other South East Asian countries, at 4.88 percent.

Each year, about 14 million women experience PPH resulting in about 70,000 maternal deaths globally, according to the World Health Organisation.

Call for actions

The findings call for more vigilance among healthcare providers attending labour and births to identify women at risk and plan for early interventions to prevent primary PPH.

The study recommends the need to provide evidence to healthcare providers, reproductive health programmes at the ministry of health, and key stakeholders.

This is to develop appropriate policies and strategic interventions to improve the care of women during pregnancy, childbirth, and after delivery to reduce the impact of primary PPH and its outcomes.

“Concerted efforts are required from policymakers, health managers and service providers to improve quality of proactive prevention of PPH through early identification of women at risk of primary PPH,” says the study.

The researchers say that more needs to be done to achieve the 2030 Sustainable Development Goals target of less than 70 per 100,000 live births.

The causes and risk factors identified in the study are expected to help predict PHH and help healthcare providers in better management of PPH in all women giving birth.

The findings of the study would enable policymakers, health managers and service providers to estimate the burden of the primary PPH and risk factors in the country.