Postpartum Hemorrhage and Maternal Deaths in North East India

K. Pratima Devi^*, L. Ranjit Singh, L. Bimolchandra Singh, M. Rameshwar Singh, N. Nabakishore Singh

Regional Institute of Medical Sciences, Imphal, India.

DOI: 10.4236/ojog.2015.511089                

Abstract

Hemorrhage, usually occur in the postpartum period, is responsible between one quarter and one third of obstetric deaths. According to the world health organization, obstetrics hemorrhage causes 127,000 deaths annually worldwide and is the leading cause of maternal mortality. Postpartum hemorrhage (PPH) is a frequent complication of delivery and its incidence is commonly reported as 2% - 4% after vaginal delivery and 6% after cesarean section with uterine atony being the cause in about 50% cases. The risk of dying from PPH depends not only on the amount and the rate of blood loss but also the health status of the woman. PPH remains the number one killer of mothers and accounts about 28% of all maternal deaths in developing countries. There is an increase risk in the PPH even in developed countries due to number of changes in recent years. In India, Maternal mortality rate (MMR) is 212 but in the state of Manipur (Regional Institute of Medical Sciences, RIMS), situated in the far corner of North East MMR is 91.68 (94 maternal deaths/102525 live births during year 2000-2010). Out of 94 deaths, 53.19% died due to hemorrhage and PPH accounts about 21.27% of total deaths. Again, almost all these PPH died within the first 24 hours of admission. High parity and home delivery brought late due to varied reasons with preexisting anemia are the common problems on analysis of maternal deaths due to PPH in our set up. Whatever the cause, death should be preventable and outcome is largely dependent upon timely interference and efficiency and vigor of medical practitioners. A pregnant woman and her family must understand the risks involved in each pregnancy. Even with different interventions and blood transfusion facility, maternal deaths cannot be brought down to zero. But the best available health care facilities should be made available to all.

Keywords

Postpartum Hemorrhage, Maternal Mortality, Cesarean

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	World Health Organization (2005) Attending to 136 Million Births, Every Year. Make Every Mother and Child Count. The World Report 2005. World Health Organization, Geneva, 62-63.
[2]	World Health organization, U.N.C.F, United Nations Population Fund and World Bank (2007) Maternal Mortality in 2005. Estimates Developed by WHO, UNICEF, UNFPA, and the World Bank, Geneva. http://www.who.int/reproductive-health/publications/maternal_mortality_2005/mme_2005.pdf
[3]	AbouZahr, C. (1998) Antepartum and Postpartum Hemorrhage. In: Murray, L.J. and Boston, A., Eds., Health Dimensions of Sex and Reproduction, Harvard School of Public Health on Behalf of the World Health Organization and the World Bank, 165-187
[4]	World Health Organization (2008) Reducing the Burden: Postpartum Hemorrhage. http://www.who.int/maternal_child_adolescent/documents/newsletter/mps_newsletter_issue4.pdf
[5]	Khan, K.S., et al. (2006) WHO Analysis of Causes of Maternal Death: A Systematic Review. The Lancet, 367, 1066-1074. http://dx.doi.org/10.1016/S0140-6736(06)68397-9
[6]	Magnann, E.F., Evans, S., Chauhan, S.P., Lanneau, G., Fisk, A.D. and Morrison, J.C. (2005) The Length of the Third Stage of Labor and the Risk of Postpartum Hemorrhage. Obstetrics and Gynecology, 105, 290-293.
[7]	Rao, K.A. (2001) Presidential Address. The Journal of Obstetrics and Gynecology of India, 51, 25-28.
[8]	United Nations (2015) UN Millennium Development Goals. http://www.un.org/millenniumgoals/
[9]	Bhat, P.N., Navneetham, K. and Rajan, S.I. (1995) Maternal Mortality in India: Estimates from a Regression Model. Studies in Family Planning, 26, 217-232. http://dx.doi.org/10.2307/2137847
[10]	Registrar General (2011) Special Bulletin on Maternal Mortality in India 2007-09. Sample Registration System. Government of India, New Delhi.
[11]	Amy, J.J. (1998) Severe Postpartum Hemorrhage: A Rational Approach. The National Medical Journal of India, 11, 86-88.
[12]	MacDorman, M.F., Menacker, F. and Declercq, E. (2008) Cesarean Birth in the United States: Epidemiology, Trends, and Outcomes. Clinics in Perinatology, 35, 293-307. http://dx.doi.org/10.1016/j.clp.2008.03.007
[13]	Bateman, B.T., Berman, M.F., Riley, L.E. and Leffert, L.R. (2010) The Epidemiology of Postpartum Hemorrhage in a Large, Nationwide Sample of Deliveries. Anesthesia and Analgesia, 110, 1368-1373. http://dx.doi.org/10.1213/ANE.0b013e3181d74898
[14]	Karen, L.M., Steven, W.H. and Sim, S.G. (2006) Preventing Postpartum Hemorrhage: Managing the Third Stage of Labor. American Family Physician, 73, 1025-1028.
[15]	Nour, N.M. (2008) An Introduction to Maternal Mortality. Reviews in Obstetrics & Gynecology, 1, 77-81.
[16]	Devi, K.P., Singh, C.M. and Devi, S.R. (2012) Maternal Mortality and Its Causes in a Tertiary Centre. The Journal of Obstetrics and Gynecology of India, 62, 168-171. http://dx.doi.org/10.1007/s13224-012-0169-1
[17]	Dutta, D.K. (2012) Insight Maternal Mortality, an Indian Facebook. Jaypee Brothers Medical Publishers Pvt. Ltd., New Delhi.
[18]	Ramachandra Bhat, P.B., Navada, M.H., Rao, S.V. and Nagarathna, G. (2013) Evaluation of Obstetric Admissions to Intensive Care Unit of Tertiary Referral Center in Coastal India. Indian Journal of Critical Care Medicine, 17, 34-37. http://dx.doi.org/10.4103/0972-5229.112156