Objective: To determine the incidence
of primary postpartum haemorrhage, identify risk/aetiological factors
contributing to primary postpartum haemorrhage and review the different
therapeutic approaches in the management of primary postpartum haemorrhage.
Method: A retrospective case-control study of all patients with primary
postpartum haemorrhage from January 1, 2001 to December 31, 2010 at Olabisi Onabanjo
University Teaching Hospital, Sagamu, Nigeria. Result: In the period under
review, 272 cases of primary postpartum haemorrhage were documented while there
were a total of 5929 deliveries, giving an incidence of 1 in 26 (25.6%). The
average blood loss in the cases reviewed was 1550 mls whilst in the controls,
the average blood loss was 200 mls. There was statistical significant
difference between the grandmultiparous cases and grandmultiparous controls
(58.4% versus 16.5%, OR = 6.74, p < 0.05), suggesting that grandmultiparity
may be an implicated factor in primary postpartum haemorrhage. In the unbooked
cases, retained placenta was the major cause of primary postpartum haemorrhage
constituting 109 (51.7%), whereas in booked cases, uterine atony contributed
70.5% to primary postpartum haemorrhage. Four maternal deaths were recorded
giving a case fatality rate of 1.5%; all were unbooked. Conclusion: Postpartum
haemorrhage ranks high in the list of causes of maternal death and the case
fatality rate can be very high. Prevention is the key to reducing the incidence
of PPH and its sequale, with preventive measures based upon the identification
of risk factors, surveillance of women at risk and seemingly not at risk and
avoidance of procedure during delivery which could potentially result in
complications.