Author(s)

Rafiki Nickson Mjema^1*, Amani Idris Kikula¹, Furaha August¹, Fadhlun Alwy Al-Beity¹, Ali Said¹, Phineas F. Sospeter², Nasra Batchu³, Benjamin Shayo⁴, Damian Jeremiah⁵, Ponsian P. Kunambi¹, John Somi¹, Patricia Swai^3,5

¹Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, MUHAS, Dar es Salaam, Tanzania.
²Department of Reproductive, Maternal and Child Health, Ministry of Health, Dodoma, Tanzania.
³Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi Kilimanjaro, Tanzania.
⁴Department of Obstetrics and Gynecology, Baylor’s College, Lilongwe, Malawi.
⁵Kilimanjaro Christian Medical University College, Moshi Kilimanjaro, Tanzania.

Worldwide obstetric hemorrhage remains the leading cause of maternal mortality, accounting for over one quarter of maternal deaths. Over half of these deaths occur in Sub-Saharan Africa with mortality rates of 500 - 1000 per 100,000 births, compared to approximately 5 - 10 in developed countries. Over decades in Sub Saharan Africa preventive measures and treatment protocols have been made to reduce maternal mortality caused by PPH. While rates of postpartum hemorrhage have continued to rise, there is a need to evaluate if its etiology and patterns have changed over time. Broad Objective: This study aims at describing trends in incidence, causes and maternal outcomes of Postpartum Hemorrhage at Muhimbili National Hospital for a period of 7 years. Methodology: This is a retrospective descriptive hospital-based study that has included all cases of postpartum hemorrhage at Muhimbili National Hospital, a tertiary hospital in Tanzania from 2014 to 2020. The data was analyzed using SPSS Version 26 and presented using frequency tables, figures and percentages. The trends of postpartum hemorrhage over time were determined using chi-square test and P-value where less than 0.05 was considered statistically significant. Results: Overall, the incidence of postpartum hemorrhage has been fluctuating over the years with minimum of 1.78% and maximum of 2.87% with no statistical significance. Out of 1113 enrolled cases of PPH, 422 (37.9%) were attributed to genital tears followed by uterine atony 285 (25.6%). A statistically significant increase in linear trend was observed in the postpartum hemorrhage cases due to uterine atony, uterine rupture and sub analysis on genital tears (cervical tear). Overall, there was a statistically significant change in trend of maternal outcomes throughout the years, with a P-value < 0.001 and likelihood of complications increasing over time. Conclusion: The trend in the incidence of postpartum hemorrhage has been fluctuating over the years during the study period. The leading cause of postpartum hemorrhage was genital tears, followed by uterine atony with a significant increase in adverse maternal outcomes over the years. Continuous health education to medical personnel to improve timely and proper diagnosis of women in danger of PPH and timely referral, thus improve maternal morbidity and mortality.

Postpartum Hemorrhage, Incidence, Causes, Maternal Outcomes and Tanzania

Mjema, R. , Kikula, A. , August, F. , Al-Beity, F. , Said, A. , Sospeter, P. , Batchu, N. , Shayo, B. , Jeremiah, D. , Kunambi, P. , Somi, J. and Swai, P. (2023) Postpartum Hemorrhage: Incidence, Causes and Maternal Outcomes at Muhimbili National Hospital, Tanzania—A Retrospective Descriptive Hospital-Based Study. Open Journal of Obstetrics and Gynecology, 13, 1244-1258. doi: 10.4236/ojog.2023.137106.